1114090909 NPI number — CLAY COUNTY RESCUE SQUAD

Table of content: (NPI 1114090909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114090909 NPI number — CLAY COUNTY RESCUE SQUAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY COUNTY RESCUE SQUAD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114090909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36251-0428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-396-0445
Provider Business Mailing Address Fax Number:
256-396-0446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
453 TAYLOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-396-0445
Provider Business Practice Location Address Fax Number:
256-396-0446
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
PETE
Authorized Official Middle Name:
DWIGHT
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
256-396-0445

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  176 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51026201 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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