Provider Demographics
NPI:1477627024
Name:CITY OF PRATTVILLE
Entity Type:Organization
Organization Name:CITY OF PRATTVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-358-3238
Mailing Address - Street 1:102 MAIN ST W
Mailing Address - Street 2:SUITE C
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-3034
Mailing Address - Country:US
Mailing Address - Phone:334-358-3670
Mailing Address - Fax:334-358-0113
Practice Address - Street 1:102 MAIN ST W
Practice Address - Street 2:SUITE C
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3034
Practice Address - Country:US
Practice Address - Phone:334-358-3670
Practice Address - Fax:334-358-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0510-50157OtherBLUE CROSS
AL000050157Medicaid
AL590000128OtherRAILROAD MEDICARE
AL000050157Medicaid
AL=========36067 0001OtherTRICARE