Provider Demographics
NPI:1427141126
Name:CITY OF MOUNTAIN BROOK
Entity type:Organization
Organization Name:CITY OF MOUNTAIN BROOK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:EZEKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:205-802-3838
Mailing Address - Street 1:PO BOX 130597
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-0597
Mailing Address - Country:US
Mailing Address - Phone:205-956-1172
Mailing Address - Fax:205-384-9758
Practice Address - Street 1:100 HOYT LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-3710
Practice Address - Country:US
Practice Address - Phone:205-802-3838
Practice Address - Fax:205-879-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL03183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1427141126OtherTRICARE SOUTH
AL200037116Medicaid
AL510-26069OtherBCBS
AL590009826Medicare PIN
AL510-26069OtherBCBS
AL000026069Medicare PIN