City of Goodwater/Amb SRV
Organization Active NPI Land Ambulance · Goodwater, AL
NPI 1215095088 · NPPES record last updated Aug 21, 2007
Key facts
- NPI
- 1215095088
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 246 (AL)
- Legal business name
- CITY OF GOODWATER/AMB SRV
- Practice address
- 55 Main St.
Goodwater, AL 35072 - Phone
- (256) 839-5521
- NPI assigned
- Dec 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Elmore Unbehant
- Title
- Asst Chief
- Phone
- (256) 839-5521
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140724000175 | AL | Part B Supplier - Ambulance Service Supplier | 2961628144 | Practice locations: Goodwater, AL |
National Provider Directory
Locations
22534 Al Hwy 9
Goodwater, AL 35072
Phone (256) 236-6005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 246 | AL | Yes |
Addresses
Primary practice location
55 Main St.
Goodwater, AL 35072
Mailing address
PO Box 45
Goodwater, AL 35072-0045
Phone (256) 839-5521
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51051665 | Other | AL | BLUECROSS BLUESHIELD |
| 590012097 | Other | AL | RAILROAD MEDICARE |
| 000051665 | Medicaid | AL |
Other providers in Goodwater, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.