Provider Demographics
NPI:1669564274
Name:NEW SITE VOLUNTEER FIRE AMBULANCE SERVICE
Entity type:Organization
Organization Name:NEW SITE VOLUNTEER FIRE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-825-1078
Mailing Address - Street 1:12791 HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:NEW SITE
Mailing Address - State:AL
Mailing Address - Zip Code:36256-3258
Mailing Address - Country:US
Mailing Address - Phone:256-825-1078
Mailing Address - Fax:
Practice Address - Street 1:12791 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:NEW SITE
Practice Address - State:AL
Practice Address - Zip Code:36256-3258
Practice Address - Country:US
Practice Address - Phone:256-825-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000053414Medicaid
AL510-53414OtherBLUE CROSS
AL000053414Medicare PIN