Organization
LIFEGUARD AMBULANCE SERVICE OF ALABAMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ROCHE (OWNER)
(205) 949-1719
Entity
Organization
Contact information
Practice address
115 WALTER DAVIS DR, SUITE C, BIRMINGHAM, AL 35209-2847
(205) 380-2065
Mailing address
PO BOX 190007, BIRMINGHAM, AL 35219-0007
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
831
AL
341600000X
Ambulance
971
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05373267
—
MS
05
—
108334
—
FL
05
—
128069
—
AL
05
—
136373
—
AL
01
—
1528067881
TRICARE-SOUTH
AL
01
—
51121572
BCBS-AL
AL
01
—
51550455
BCBS-AL
AL
Enumeration date
12/21/2010
Last updated
07/24/2013
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