Provider Demographics
NPI:1467843573
Name:PORTERFIELD, ERNEST
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:PORTERFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 CARMICHAEL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2942
Mailing Address - Country:US
Mailing Address - Phone:334-244-8968
Mailing Address - Fax:334-244-8960
Practice Address - Street 1:4183 CARMICHAEL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-244-8968
Practice Address - Fax:334-244-8960
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7555343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)