Provider Demographics
NPI:1245226620
Name:TOWN OF BRANTLEY/FIRE &
Entity Type:Organization
Organization Name:TOWN OF BRANTLEY/FIRE &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-429-3045
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:BRANTLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36009-0383
Mailing Address - Country:US
Mailing Address - Phone:334-527-3337
Mailing Address - Fax:
Practice Address - Street 1:9413 W EMMETT ST
Practice Address - Street 2:
Practice Address - City:BRANTLEY
Practice Address - State:AL
Practice Address - Zip Code:36009-0383
Practice Address - Country:US
Practice Address - Phone:334-527-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051050150OtherBLUE CROSS & BLUE SHIELD
AL200021105Medicaid
AL200021105Medicaid