MEDICARE: HAYNES AMBULANCES OF WETUMPKA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	952	AL

General Provider Information

NPI Number	:	1003004722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYNES AMBULANCES OF WETUMPKA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1308
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-0022
Country	:	US
Telephone Number	:	334-567-7039
Fax Number	:	334-285-2170

Provider Business Practice Location Address
First Line	:	527 HOSPITAL DR
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-1626
Country	:	US
Telephone Number	:	334-567-7039
Fax Number	:	334-285-2170

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	MR. JOSEPH PERRY HAYNES
Credential	:
Telephone Number	:	334-567-7039

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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