=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578648952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED-CALL AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 7TH AVE SE STE B
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-340-0555
-----------------------------------------------------
Fax | 256-340-0501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 7TH AVE SE STE B
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-340-0555
-----------------------------------------------------
Fax | 256-340-0501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID CHILDERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-340-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 904
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------