# FAYETTE MEDICAL CENTER AMBULANCE

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

## Provider details

- **NPI number:** 1720163090
- **Authorized official:** KERI H HINDMAN (PAITENT ACCOUNTS DIRECTOR)
- **Authorized official phone:** (205) 759-7379

## Contact information

- **Practice address:** 1653 TEMPLE AVE N, FAYETTE, AL 35555-1314
- **Practice address phone:** (205) 343-8500
- **Practice address fax:** (205) 759-6397
- **Mailing address:** 809 UNIVERSITY BLVD E, TUSCALOOSA, AL 35401-2029
- **Mailing address phone:** (205) 343-8500
- **Mailing address fax:** (205) 759-6397

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 226 | AL | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 04/22/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200029101 | — | AL |
| 01 | — | CG6924 | RAILROAD MEDICARE | AL |