=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760766596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESCAMBIA COUNTY HEALTH CARE AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2011
-----------------------------------------------------
Last Update Date | 09/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 BELLEVILLE AVE
-----------------------------------------------------
City | BREWTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36426-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-809-8398
-----------------------------------------------------
Fax | 251-809-8459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 908
-----------------------------------------------------
City | BREWTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36427-0908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-809-8398
-----------------------------------------------------
Fax | 251-809-8459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. CHRIS B GRIFFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-809-8398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 197
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------