| Name: | Roger Vines, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Jan 2006 (19 years ago) |
| Entity Number: | 000-473-119 |
| Register Number: | 000473119 |
| ZIP code: | 36862 |
| County: | Chambers |
| Place of Formation: | Chambers County |
| Principal Address: | LAFAYETTE, AL |
| Registered Office Street Address: | 500 B STREETLAFAYETTE, AL 36862 |
Activities
NON-EMERGENCY AMBULANCE SERVICE OPERATION
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497837421 | 2006-10-19 | 2014-04-06 | 211 B ST, P.O. BOX 198, LAFAYETTE, AL, 368622095, US | 211 B ST, LAFAYETTE, AL, 368622095, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-864-7128 |
| Fax | 3348648184 |
Authorized person
| Name | ROGER VINES LLC |
| Role | OWNER/DIRECTOR |
| Phone | 3348647128 |
Taxonomy
| Taxonomy Code | 3416L0300X - Land Ambulance |
| License Number | 411 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS OF ALABAMA |
| Number | 051052949 |
| State | AL |
| Issuer | MEDICAID |
| Number | 104579 |
| State | AL |
| Name | Role |
|---|---|
| VINES, ROGER | Agent |
| Name | Role |
|---|---|
| VINES, ROGER | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
