Provider Demographics
NPI:1578537163
Name:PICKENS CO AMBULANCE SRVC
Entity Type:Organization
Organization Name:PICKENS CO AMBULANCE SRVC
Other - Org Name:PICKENS COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-247-4748
Mailing Address - Street 1:PO BOX 2788
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2788
Mailing Address - Country:US
Mailing Address - Phone:205-752-5866
Mailing Address - Fax:205-345-7911
Practice Address - Street 1:40 FIRE HOUSE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:AL
Practice Address - Zip Code:35447-8002
Practice Address - Country:US
Practice Address - Phone:205-367-8086
Practice Address - Fax:205-345-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS001557550Medicaid
LA1426466Medicaid
TN0161517OtherBCBS OF TN
AL051057951OtherBCBS OF AL
AL200054105Medicaid
AL3684OtherHEALTHSPRING OF AL
AL590008126OtherPALMETTO GOVT BENEFIT ADM
AL080030900OtherBLACK LUNG
LA1426466Medicaid