WIREGRASS LIFE FLIGHT (NPI# 1063888352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063888352 |
| Entity Type | Organization |
| Organization Name | WIREGRASS LIFE FLIGHT |
| Practice Address |
1108 Ross Clark Cir Dothan AL 36301 |
| Mailing Address |
10888 S 300 W South Jordan UT 84095-4043 |
| Practice Telephone | 8016194900 |
| Practice Fax Number | 8019836052 |
| Mailing Telephone | 8016194900 |
| Mailing Fax Number | 8019836052 |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2018-08-03 |
| Authorized Official Name | ERIC THOMAS (SVP OF REVENUE MANAGEMENT) |
| Authorized Official Telephone | 8772885340 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3416A0800X |
Ambulance Specialization: Air Transport |
Transportation Services |
| Street Address |
1108 ROSS CLARK CIR |
| City | DOTHAN |
| State | AL |
| Zip Code | 36301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576268 | Judith L Bosse | Nurse Practitioner | 1108 Ross Clark Cir, Hospitalist Office, Dothan, AL 36301-3022 | 2005-05-27 |
| 1811597073 | Michael Brian Pierce | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-10-27 |
| 1659990901 | Robert Dale Garrett | Nurse Anesthetist, Certified Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-04-15 |
| 1861028607 | Richard Henry Jester | Physician Assistant | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-03-12 |
| 1467017335 | Keaton Peak | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301 | 2019-05-07 |
| 1396214060 | Shalita Clark | Psychiatry & Neurology | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-11-24 |
| 1619452760 | Drew Mckenzie Hubbard | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-09-25 |
| 1609359926 | Amber Salmon | Dietitian, Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-09-12 |
| 1255825832 | Shannon Louette Skaug | Nurse Practitioner | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-06-18 |
| 1225529712 | Vyshnavi Kone | Student in an Organized Health Care Education/Training Program | 1108 Ross Clark Cir, Dothan, AL 36301 | 2018-05-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043862931 | Pharmacy Center South LLC | Pharmacy | 2826 Ross Clark Circle, Suite 103, Dothan, AL 36301 | 2019-07-11 |
| 1851879167 | Attallah Cotton | Social Worker | 101 Eastridge Dr, Dothan, AL 36301 | 2018-07-31 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1750805818 | Kimberly Danielle Austin | Speech-Language Pathologist | 404 Darlington Cir, Dothan, AL 36301 | 2017-07-31 |
| 1952794885 | Lori P. Granberry | Pharmacist | 2131 Ross Clark Circle, Dothan, AL 36301 | 2015-03-17 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1720407646 | Michael Kreger | Anesthesiology | 1118 Ross Clark Cir Ste 700, Dothan, AL 36301 | 2014-04-08 |
| 1063851277 | Carlos Stanford Clark II | Family Medicine | 201 Doctors Drive, Dothan, AL 36301 | 2013-06-20 |
| 1639489313 | Robert Fort Hambaugh Jr. | Specialist | 712 Woodland Drive, Dothan, AL 36301 | 2010-10-15 |
| 1588894976 | Atwill Lamar Miller Jr. | Urology | 1908 Fairview Avenue, Dothan, AL 36301 | 2009-07-20 |
| Find all providers in zip 36301 | ||||
| Taxonomy Code | 3416A0800X |
| Grouping | Transportation Services |
| Classification | Ambulance |
| Specialization | Air Transport |
| Definition to come... |
| Notes: [1/1/2005: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174137392 | Rocky Mountain Holdings, LLC | Ambulance | 364 Airport Rd, Sylacauga, AL 35151-4576 | 2020-09-04 |
| 1528676798 | Rocky Mountain Holdings, LLC | Ambulance | 2097 County Road 177, Cusseta, AL 36852-2716 | 2020-07-14 |
| 1629626726 | Joseph Todor | Ambulance | 3190 Airport Dr, Gulf Shores, AL 36542-2818 | 2019-09-01 |
| 1396218855 | Med-trans Corporation | Ambulance | 411 Medical Park Dr, Atmore, AL 36502-3006 | 2019-01-08 |
| 1275084535 | Med-trans Corporation | Ambulance | 36276 State Highway 59, Stapleton, AL 36578-0000 | 2016-10-20 |
| 1184011272 | Rocky Mountain Holdings, LLC | Ambulance | 10101 Moffett Rd, Semmes, AL 36575-5377 | 2015-04-16 |
| 1457776197 | Haynes Life Flight LLC | Ambulance | 545 Hospital Dr, Wetumpka, AL 36092-1626 | 2014-03-04 |
| 1578835153 | Air Evac Ems Inc | Ambulance | 1020 S Cedar Ave, Demopolis, AL 36732-3308 | 2012-01-30 |
| 1740375203 | Omni Transport Systems Alabama LLC | Ambulance | 1557 Walnut Hill Cir, Birmingham, AL 35234-2820 | 2006-10-03 |
| 1750498341 | Air Evac Ems Inc. | Ambulance | 1155 Al Hwy 14, Elmore, AL 36025 | 2006-08-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.