Provider Demographics
NPI:1184430209
Name:TOWN OF BLOUNTSVILLE
Entity type:Organization
Organization Name:TOWN OF BLOUNTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:MIKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-572-5497
Mailing Address - Street 1:PO BOX 361706
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35236-1706
Mailing Address - Country:US
Mailing Address - Phone:205-823-7076
Mailing Address - Fax:205-978-9876
Practice Address - Street 1:68053 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031-3361
Practice Address - Country:US
Practice Address - Phone:205-572-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport