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General NPI Number Information
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NPI Number | 1306896576
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Entity Type | Organization
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Legal Business Name | FOUNTAIN AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 5237 HALLS MILL RD BUILDING D
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City | MOBILE
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State | AL
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Zip | 36619-9603
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Country | US
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Telephone | 251-478-7200
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Fax | 251-478-3888
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Provider Business Mailing Address
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Address Line | PO BOX 198408
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City | ATLANTA
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State | GA
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Zip | 30384-8408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK BRUNING
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Credential |
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Telephone | 303-495-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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