Organization
CITY OF PRATTVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID TUCKER (CHIEF)
(334) 358-3238
Entity
Organization
Contact information
Practice address
102 MAIN ST W, SUITE C, PRATTVILLE, AL 36067-3034
(334) 358-3670
(334) 358-0113
Mailing address
102 MAIN ST W, SUITE C, PRATTVILLE, AL 36067-3034
(334) 358-3670
(334) 358-0113
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
348
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000050157
—
AL
01
—
0510-50157
BLUE CROSS
AL
01
—
590000128
RAILROAD MEDICARE
AL
Enumeration date
11/17/2006
Last updated
09/11/2008
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