Provider Demographics
NPI:1285741041
Name:KELLEY'S AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:KELLEY'S AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:251-368-5915
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36504-0530
Mailing Address - Country:US
Mailing Address - Phone:215-368-5915
Mailing Address - Fax:251-368-6161
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-1714
Practice Address - Country:US
Practice Address - Phone:251-368-5915
Practice Address - Fax:251-368-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL899341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525686OtherBCBSAL