Provider Demographics
NPI:1295833093
Name:TOWN OF ECLECTIC
Entity Type:Organization
Organization Name:TOWN OF ECLECTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN CLERK
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-541-4429
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:140 1ST AVE
Practice Address - Street 2:
Practice Address - City:ECLECTIC
Practice Address - State:AL
Practice Address - Zip Code:36024
Practice Address - Country:US
Practice Address - Phone:334-541-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000037499Medicaid
AL51037499OtherBCBS OF AL
AL000037499Medicaid
AL51037499OtherBCBS OF AL