=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386730620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF SLOCOMB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 S STATE HIGHWAY 103
-----------------------------------------------------
City | SLOCOMB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36375-6533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-886-7419
-----------------------------------------------------
Fax | 334-886-9896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 608
-----------------------------------------------------
City | SLOCOMB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36375-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-886-7419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ASSISTANT
-----------------------------------------------------
Name | CANDY ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-589-3038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 874
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------