Provider Demographics
NPI:1548246010
Name:LAWRENCE COUNTY EMERGENCY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:LAWRENCE COUNTY EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DAREL
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:256-974-3711
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-0520
Mailing Address - Country:US
Mailing Address - Phone:256-974-3711
Mailing Address - Fax:256-974-7956
Practice Address - Street 1:11227 AL HIGHWAY 157
Practice Address - Street 2:SUITE A
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1983
Practice Address - Country:US
Practice Address - Phone:256-974-3711
Practice Address - Fax:256-974-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200040104Medicaid
AL510 39489OtherBLUE CROSS BLUE SHIELD
AL200040104Medicaid