Healthcare Provider Details

I. General information

NPI: 1366623043
Provider Name (Legal Business Name): HAYNES AMBULANCE OF ELMORE COUNTY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
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 1515
WETUMPKA AL
36092-0028
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-7039
  • 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 Code3416L0300X
TaxonomyLand Ambulance
License Number956
License Number StateAL

VIII. Authorized Official

Name: BRANDEE HAYNES BARRETT
Title or Position: PARTNER
Credential: EMT-P
Phone: 334-241-5224