Healthcare Provider Details

I. General information

NPI: 1457776197
Provider Name (Legal Business Name): HAYNES LIFE FLIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 HOSPITAL DR
WETUMPKA AL
36092-1626
US

IV. Provider business mailing address

PO BOX 1515
WETUMPKA AL
36092-0028
US

V. Phone/Fax

Practice location:
  • Phone: 334-241-5224
  • Fax: 334-567-6850
Mailing address:
  • Phone: 334-241-5224
  • Fax: 334-567-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK EDWIN BARRETT
Title or Position: COO
Credential: NREMT-P
Phone: 334-241-5268