Provider Demographics
NPI:1104205673
Name:GREEN POND VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:GREEN POND VOLUNTEER FIRE DEPT
Other - Org Name:WEST ALABAMA EMERGENCY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-938-9991
Mailing Address - Street 1:PO BOX 361706
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35236-1706
Mailing Address - Country:US
Mailing Address - Phone:205-823-7076
Mailing Address - Fax:205-978-9876
Practice Address - Street 1:19629 EASTERN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188
Practice Address - Country:US
Practice Address - Phone:205-938-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN POND VOLUNTEER FIRE DEPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport