Organization
FOUNTAIN AMBULANCE SERVICE INC
Active
Other names
American Medical Response
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BRUNING (PRESIDENT)
(303) 495-1220
Entity
Organization
Contact information
Practice address
5237 HALLS MILL RD, BUILDING D, MOBILE, AL 36619-9603
(251) 478-7200
(251) 478-3888
Mailing address
PO BOX 198408, ATLANTA, GA 30384-8408
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20049104
—
AL
01
—
50165FOU
BLUECROSS BLUESHIELD OF A
AL
01
—
590011529
RAILROAD MEDICARE
AL
01
—
AL0000D100169
SECTION 1011
AL
Enumeration date
05/11/2006
Last updated
02/20/2012
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