Provider Demographics
NPI:1497853923
Name:CITY OF LANETT
Entity Type:Organization
Organization Name:CITY OF LANETT
Other - Org Name:CITY OF LANETT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-644-5225
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-0290
Mailing Address - Country:US
Mailing Address - Phone:334-644-5225
Mailing Address - Fax:
Practice Address - Street 1:401 N LANIER AVE
Practice Address - Street 2:
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-2019
Practice Address - Country:US
Practice Address - Phone:334-644-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL590000497OtherRAILROAD MEDICARE
AL051053874OtherBLUE CROSS BLUE SHIELD AL
AL000053874Medicaid
AL000053874Medicare PIN