Provider Demographics
NPI:1497177695
Name:SHOALS AMBULANCE LLC
Entity Type:Organization
Organization Name:SHOALS AMBULANCE LLC
Other - Org Name:PRIORITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICKEUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-597-4911
Mailing Address - Street 1:5251 S EAST ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2038
Mailing Address - Country:US
Mailing Address - Phone:844-597-4911
Mailing Address - Fax:
Practice Address - Street 1:310 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5770
Practice Address - Country:US
Practice Address - Phone:256-275-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport