NPIMap

Organization Active NPI

Lawrence County Emergency Medical Services, Inc.

Doing business as Greg's Ambulance Service

  • Land Ambulance
  • Moulton, AL
National Provider Identifier
1548246010
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
725 Issued in AL
Legal business name
LAWRENCE COUNTY EMERGENCY MEDICAL SERVICES, INC.
Doing business as
Greg's Ambulance Service
Practice address
11227 Al Highway 157
Suite a
Moulton, AL 35650-1983
Phone
(256) 974-3711
Fax
(256) 974-7956
NPI assigned
Dec 16, 2005
Last updated
Oct 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gregory Darel Randolph, PARAMEDIC
Title
President
Phone
(256) 974-3711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 725 AL Primary

Addresses

Primary practice location

11227 Al Highway 157
Suite a
Moulton, AL 35650-1983

Mailing address

PO Box 520
Moulton, AL 35650-0520
Phone (256) 974-3711

Other identifiers 2

IdentifierTypeStateIssuer
200040104MedicaidAL
510 39489OtherALBLUE CROSS BLUE SHIELD

Other names 1

  • Greg's Ambulance Service Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101229000136 AL Part B Supplier - Ambulance Service Supplier 6608064035 Practice locations: Moulton, AL

National Provider Directory

National Provider Directory
Tax ID family
Greg's Ambulance Service2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11227 AL Highway 157
Ste A
Moulton, AL 35650
Phone (256) 974-3711

13414 AL Highway 157
Moulton, AL 35650
Phone (256) 974-3611

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1548246010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "MOULTON",
            "state": "AL",
            "postal_code": "356500520",
            "telephone_number": "256-974-3711",
            "fax_number": "256-974-7956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11227 AL HIGHWAY 157",
            "address_2": "SUITE A",
            "city": "MOULTON",
            "state": "AL",
            "postal_code": "356501983",
            "telephone_number": "256-974-3711",
            "fax_number": "256-974-7956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE COUNTY EMERGENCY MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "DAREL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-974-3711",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AL",
            "license": "725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200040104",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "510 39489",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greg's Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moulton, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.