Provider Demographics
NPI:1154470961
Name:CITY OF TRUSSVILLE
Entity Type:Organization
Organization Name:CITY OF TRUSSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:SHOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-823-7076
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 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1434
Practice Address - Country:US
Practice Address - Phone:205-655-7478
Practice Address - Fax:205-856-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3679341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00134702OtherRAILROAD MEDICARE
AL51026Medicare ID - Type Unspecified