NPIMap

Organization Active NPI

Fayette Medical Center Ambulance

  • Land Ambulance
  • Fayette, AL
National Provider Identifier
1720163090
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
226 Issued in AL
Legal business name
FAYETTE MEDICAL CENTER AMBULANCE
Practice address
1653 Temple Ave N
Fayette, AL 35555-1314
Phone
(205) 343-8500
Fax
(205) 759-6397
NPI assigned
Oct 26, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Keri H Hindman
Title
Paitent Accounts Director
Phone
(205) 759-7379

National Provider Directory

National Provider Directory
Tax ID family
John Henry Ploussard MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 226 AL Primary

Addresses

NPPES NPI Registry

Primary practice location

1653 Temple Ave N
Fayette, AL 35555-1314

Mailing address

809 University Blvd E
Tuscaloosa, AL 35401-2029
Phone (205) 343-8500

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
CG6924OtherALRAILROAD MEDICARE
200029101MedicaidAL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 22, 2022.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1720163090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 UNIVERSITY BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012029",
            "telephone_number": "205-343-8500",
            "fax_number": "205-759-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-343-8500",
            "fax_number": "205-759-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEDICAL CENTER AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "HINDMAN",
        "authorized_official_first_name": "KERI",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PAITENT ACCOUNTS DIRECTOR",
        "authorized_official_telephone_number": "205-759-7379"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AL",
            "license": "226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG6924",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200029101",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayette, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.