Provider Demographics
NPI:1003004722
Name:HAYNES AMBULANCES OF WETUMPKA, LLC
Entity Type:Organization
Organization Name:HAYNES AMBULANCES OF WETUMPKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-567-7039
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-0022
Mailing Address - Country:US
Mailing Address - Phone:334-567-7039
Mailing Address - Fax:334-285-2170
Practice Address - Street 1:527 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-1626
Practice Address - Country:US
Practice Address - Phone:334-567-7039
Practice Address - Fax:334-285-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL952341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance