Provider Demographics
NPI:1912952896
Name:DECATUR EMS
Entity type:Organization
Organization Name:DECATUR EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:STANMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-547-6119
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0303
Mailing Address - Country:US
Mailing Address - Phone:256-547-6119
Mailing Address - Fax:256-546-2981
Practice Address - Street 1:1207 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4334
Practice Address - Country:US
Practice Address - Phone:256-547-6119
Practice Address - Fax:256-546-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL050110341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance