| Name: | Lifeguard Ambulance Service of Alabama, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 05 Jun 2003 (21 years ago) (Companies founded in June 2003) |
| Date of dissolution: | 02 Dec 2014 |
| Entity Number: | 000-690-553 |
| Register Number: | 000690553 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Mailing Address: | 2000 INTERSTATE PARK DR STE 2O4MONTGOMERY, AL 36109 |
| Registered Office Street Address: | 150 SOUTH PERRY STREETMONTGOMERY, AL 36104 |
Activities
AMBULANCE SERVICE AND OTHER MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386947901 | 2010-12-21 | 2013-07-24 | PO BOX 190007, BIRMINGHAM, AL, 352190007, US | 115 WALTER DAVIS DR, SUITE C, BIRMINGHAM, AL, 352092847, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 205-380-2065 |
Authorized person
| Name | JOHN ROCHE |
| Role | OWNER |
| Phone | 2059491719 |
Taxonomy
| Taxonomy Code | 341600000X - Ambulance |
| License Number | 831 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 341600000X - Ambulance |
| License Number | 971 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 128069 |
| State | AL |
| Issuer | TRICARE-SOUTH |
| Number | 1528067881 |
| State | AL |
| Issuer | BCBS-AL |
| Number | 51121572 |
| State | AL |
| Issuer | MEDICAID |
| Number | 05373267 |
| State | MS |
| Issuer | MEDICAID |
| Number | 108334 |
| State | FL |
| Issuer | MEDICAID |
| Number | 136373 |
| State | AL |
| Issuer | BCBS-AL |
| Number | 51550455 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CSC-LAWYERS INCORPORATING SVC INC | Agent | 2711 CENTERVILLE ROAD SUITE 400WILMINGTON, DE 19808 |
| Name | Role |
|---|---|
| LIFEGUARD TRANSPORTATION SERVICE INC | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
