Provider Demographics
NPI:1548228240
Name:EMERGYSTAT OF SULLIGENT
Entity Type:Organization
Organization Name:EMERGYSTAT OF SULLIGENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-695-9800
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-1497
Mailing Address - Country:US
Mailing Address - Phone:205-695-9800
Mailing Address - Fax:205-695-7677
Practice Address - Street 1:9420 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5211
Practice Address - Country:US
Practice Address - Phone:205-695-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51030994OtherBLUE CROSS PROV #
AL51031838OtherBLUE CROSS PROVIDER NUMBE
AL51076358OtherBLUE CROSS PROV #
AL51094659OtherBLUE CROSS PROV #
AL51037974OtherBLUE CROSS PROV #
AL51096578OtherBLUE CROSS PROV #
AL51098617OtherBLUE CROSS PROV #
AL51510683OtherBLUE CROSS PROV #