=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427141126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF MOUNTAIN BROOK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 06/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HOYT LN
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35213-3710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-802-3838
-----------------------------------------------------
Fax | 205-879-5919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 130597
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35213-0597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-956-1172
-----------------------------------------------------
Fax | 205-384-9758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | MR. ROBERT W EZEKIEL
-----------------------------------------------------
Credential | PARAMEDIC
-----------------------------------------------------
Telephone | 205-802-3838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 0318
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------