Provider Demographics
NPI:1386730620
Name:TOWN OF SLOCOMB
Entity type:Organization
Organization Name:TOWN OF SLOCOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-589-3038
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-0608
Mailing Address - Country:US
Mailing Address - Phone:334-886-7419
Mailing Address - Fax:
Practice Address - Street 1:324 S STATE HIGHWAY 103
Practice Address - Street 2:
Practice Address - City:SLOCOMB
Practice Address - State:AL
Practice Address - Zip Code:36375-6533
Practice Address - Country:US
Practice Address - Phone:334-886-7419
Practice Address - Fax:334-886-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000079450Medicaid
AL51079450OtherBLUE CROSS
AL51079450OtherBLUE CROSS