Provider Demographics
NPI:1548462211
Name:AMERICAN AMBULANCE SERVCIE
Entity type:Organization
Organization Name:AMERICAN AMBULANCE SERVCIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO EMTP
Authorized Official - Phone:256-739-8530
Mailing Address - Street 1:1192 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:FALKVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35622-0000
Mailing Address - Country:US
Mailing Address - Phone:256-737-7280
Mailing Address - Fax:256-737-0845
Practice Address - Street 1:51 W 2ND ST
Practice Address - Street 2:
Practice Address - City:FALKVILLE
Practice Address - State:AL
Practice Address - Zip Code:35622-5009
Practice Address - Country:US
Practice Address - Phone:256-737-7280
Practice Address - Fax:256-737-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL802341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529890OtherBLUE CROSS
AL051550690Medicaid
AL051550690Medicaid