Provider Demographics
NPI:1649355017
Name:PLEASANT BAY AMBULANCE SERVICE
Entity type:Organization
Organization Name:PLEASANT BAY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-331-4819
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-0133
Mailing Address - Country:US
Mailing Address - Phone:256-331-4819
Mailing Address - Fax:256-331-7491
Practice Address - Street 1:1301 JACKSON AVE N
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1634
Practice Address - Country:US
Practice Address - Phone:256-331-4819
Practice Address - Fax:256-331-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51077449OtherBC/BS OF ALABAMA