Provider Demographics
NPI:1558457176
Name:NORTHWEST ALABAMA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHWEST ALABAMA HEALTH SERVICES, LLC
Other - Org Name:KELLER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-386-4550
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0610
Mailing Address - Country:US
Mailing Address - Phone:256-386-4011
Mailing Address - Fax:256-386-4685
Practice Address - Street 1:1300 S MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-6334
Practice Address - Country:US
Practice Address - Phone:256-386-4011
Practice Address - Fax:256-386-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL270341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00702047OtherMS MEDICAID GROUP NUMBER
AL051532114OtherBLUE CROSS
AL051556913Medicaid
AL051532114OtherBLUE CROSS