MEDICARE: FOUNTAIN AMBULANCE SERVICE INC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590011529	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL0000D100169	OTHER	AL	SECTION 1011
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50165FOU	OTHER	AL	BLUECROSS BLUESHIELD OF A

General Provider Information

NPI Number	:	1306896576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 198408
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5237 HALLS MILL RD
Second Line	:	BUILDING D
City	:	MOBILE
State	:	AL
Zip	:	36619-9603
Country	:	US
Telephone Number	:	251-478-7200
Fax Number	:	251-478-3888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK BRUNING
Credential	:
Telephone Number	:	303-495-1220

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/20/2012

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Directions to “FOUNTAIN AMBULANCE SERVICE INC ” Practice Location

Language	Start Address	Practice Location

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