MEDICARE: HAYNES AMBULANCE OF ELMORE COUNTY, L.L.C.

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	3416L0300X	Land Ambulance	956	AL

General Provider Information

NPI Number	:	1366623043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYNES AMBULANCE OF ELMORE COUNTY, L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 1515
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-0028
Country	:	US
Telephone Number	:	334-241-5224
Fax Number	:	334-567-6850

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	:	334-567-6850

Authorized Official
Title or Position	:	PARTNER
Name	:	BRANDEE HAYNES BARRETT
Credential	:	EMT-P
Telephone Number	:	334-241-5224

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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