| Name: | Fountain Ambulance Service, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 31 Jan 1992 (33 years ago) (Companies founded in January 1992) |
| Entity Number: | 000-147-742 |
| Register Number: | 000147742 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| Authorized Capital: | $1,000 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306896576 | 2006-05-11 | 2012-02-20 | PO BOX 198408, ATLANTA, GA, 303848408, US | 5237 HALLS MILL RD, BUILDING D, MOBILE, AL, 366199603, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-478-7200 |
| Fax | 2514783888 |
Authorized person
| Name | MARK BRUNING |
| Role | PRESIDENT |
| Phone | 3034951220 |
Taxonomy
| Taxonomy Code | 341600000X - Ambulance |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | SECTION 1011 |
| Number | AL0000D100169 |
| State | AL |
| Issuer | MEDICAID |
| Number | 20049104 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | 590011529 |
| State | AL |
| Issuer | BLUECROSS BLUESHIELD OF A |
| Number | 50165FOU |
| State | AL |
| CIK number | Mailing Address | Business Address | Phone | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1277814 | No data | 55 SHUMAN BLVD, SUITE 400, NAPERVILLE, IL, 60563 | 6308483000 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Form type | EFFECT |
| File number | 333-177015-83 |
| Filing date | 2011-10-07 |
| File | View File |
Filings since 2011-10-07
| Form type | 424B3 |
| File number | 333-177015-83 |
| Filing date | 2011-10-07 |
| File | View File |
Filings since 2011-09-27
| Form type | S-4 |
| File number | 333-177015-83 |
| Filing date | 2011-09-27 |
| File | View File |
Filings since 2005-12-08
| Form type | 424B3 |
| File number | 333-128925-142 |
| Filing date | 2005-12-08 |
| File | View File |
Filings since 2005-12-07
| Form type | CORRESP |
| Filing date | 2005-12-07 |
| File | View File |
Filings since 2005-12-06
| Form type | CORRESP |
| Filing date | 2005-12-06 |
| File | View File |
Filings since 2005-12-02
| Form type | S-4/A |
| File number | 333-128925-142 |
| Filing date | 2005-12-02 |
| File | View File |
Filings since 2005-11-23
| Form type | S-4/A |
| File number | 333-128925-142 |
| Filing date | 2005-11-23 |
| File | View File |
Filings since 2005-10-11
| Form type | S-4 |
| File number | 333-128925-142 |
| Filing date | 2005-10-11 |
| File | View File |
Filings since 2004-03-25
| Form type | 424B3 |
| File number | 333-112309-65 |
| Filing date | 2004-03-25 |
| File | View File |
Filings since 2004-03-17
| Form type | S-4/A |
| File number | 333-112309-65 |
| Filing date | 2004-03-17 |
| File | View File |
Filings since 2004-01-29
| Form type | S-4 |
| File number | 333-112309-65 |
| Filing date | 2004-01-29 |
| File | View File |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
| Name | Role |
|---|---|
| DENNY, KIMBERLY KAY | Incorporator |
| FOUNTAIN, JAMES PATRICK | Incorporator |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DCA | AWARD | VA256P0011 | 2007-10-01 | 2008-09-30 | 2009-09-30 | |||||||||||||||||||||
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| Title | AMBULANCE SERVICE FOR MOBILE OUTPATIENT CLINIC |
| NAICS Code | 621910: AMBULANCE SERVICES |
| Product and Service Codes | V225: AMBULANCE SERVICE |
Recipient Details
| Recipient | FOUNTAIN AMBULANCE SERVICE, INC. |
| UEI | RA6BGLPLXRA3 |
| Legacy DUNS | 106910904 |
| Recipient Address | UNITED STATES, 22 W MIDTOWN PARK, MOBILE, 366064148 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
