Provider Demographics
NPI:1215095088
Name:CITY OF GOODWATER/AMB SRV
Entity type:Organization
Organization Name:CITY OF GOODWATER/AMB SRV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMORE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNBEHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-839-5521
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-0045
Mailing Address - Country:US
Mailing Address - Phone:256-839-5521
Mailing Address - Fax:256-839-5663
Practice Address - Street 1:55 MAIN ST.
Practice Address - Street 2:
Practice Address - City:GOODWATER
Practice Address - State:AL
Practice Address - Zip Code:35072
Practice Address - Country:US
Practice Address - Phone:256-839-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51051665OtherBLUECROSS BLUESHIELD
AL590012097OtherRAILROAD MEDICARE
AL000051665Medicaid
AL51051665OtherBLUECROSS BLUESHIELD