# EXTENDED EMERGENCY MEDICAL SERVICES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154389971
- **Authorized official:** LARRY LUNAN (CEO)
- **Authorized official phone:** (205) 695-9800

## Contact information

- **Practice address:** 779 LAKESIDE DR, MOBILE, AL 36693-5113
- **Practice address phone:** (251) 660-0061
- **Practice address fax:** (251) 662-8205
- **Mailing address:** PO BOX 1497, VERNON, AL 35592-1497
- **Mailing address phone:** (205) 695-9800
- **Mailing address fax:** (205) 695-7677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 764 | AL | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 51050095 | BLUE CROSS PROV \# | AL |