=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518981174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMMONS AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1956 SAWYER DR
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36460-7984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-996-4727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 646
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-743-2623
-----------------------------------------------------
Fax | 251-575-4333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. GRAYSON SIMMONS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 251-743-7486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 365
-----------------------------------------------------
License Number State |
-----------------------------------------------------