# ROGER VINES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vines Ambulance Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497837421
- **Authorized official:** ROGER VINES LLC (OWNER/DIRECTOR)
- **Authorized official phone:** (334) 864-7128

## Contact information

- **Practice address:** 211 B ST, LAFAYETTE, AL 36862-2095
- **Practice address phone:** (334) 864-7128
- **Practice address fax:** (334) 864-8184
- **Mailing address:** 211 B ST, P.O. BOX 198, LAFAYETTE, AL 36862-2095
- **Mailing address phone:** (334) 864-7128
- **Mailing address fax:** (334) 864-8184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 411 | AL | Yes |

## Other

- **Enumeration date:** 10/19/2006
- **Last updated:** 04/06/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 051052949 | BC/BS OF ALABAMA | AL |
| 05 | — | 104579 | — | AL |