| Name: | South Barbour EMS, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 07 Jul 2004 (20 years ago) |
| Entity Number: | 000-560-252 |
| Register Number: | 000560252 |
| Historical Names: |
Clio Rescue Squad, Inc.
|
| County: | Barbour |
| Place of Formation: | Barbour County |
| Principal Address: | CLIO, AL |
| Registered Office Street Address: | 3311 ELAMVILLE STCLIO, AL 36017 |
| Registered Office Street Address ZIP Code: | 36017 |
Activities
EMERGENCY MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659452555 | 2006-10-18 | 2017-05-02 | PO BOX 338, CLIO, AL, 360170338, US | 3311 ELAMVILLE ST, CLIO, AL, 360172706, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 334-397-4402 |
Authorized person
| Name | RICHARD JOHNSON |
| Role | CAPTAIN |
| Phone | 3343974402 |
Taxonomy
| Taxonomy Code | 3416L0300X - Land Ambulance |
| License Number | 180 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000051591 |
| State | AL |
| Issuer | BLUE CROSS |
| Number | 510-51591 |
| State | AL |
| Name | Role |
|---|---|
| ROBINETT, ALICE H | Agent |
| Name | Role | Address |
|---|---|---|
| JOHNSON, RICHARD | Incorporator | 2159 HALLS MILL RDMOBILE, AL 36606 |
| KNIGHT, JIMMY | Incorporator | 3310 ELAMVILLE STREETCLIO, AL 36016 |
| BEACHAM, LEWIS | Incorporator | No data |
| WOOD, TINA | Incorporator | No data |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2009-03-13 | Name Change | Clio Rescue Squad, Inc. | South Barbour EMS, Inc. |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
