Healthcare Provider Details

I. General information

NPI: 1003004722
Provider Name (Legal Business Name): HAYNES AMBULANCES OF WETUMPKA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 HOSPITAL DR
WETUMPKA AL
36092-1626
US

IV. Provider business mailing address

PO BOX 1308
WETUMPKA AL
36092-0022
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-7039
  • Fax: 334-285-2170
Mailing address:
  • Phone: 334-567-7039
  • Fax: 334-285-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number952
License Number StateAL

VIII. Authorized Official

Name: MR. JOSEPH PERRY HAYNES
Title or Position: OWNER/MEMBER
Credential:
Phone: 334-567-7039