1295907095 NPI number — LEE COUNTY RESCUE SQUAD THOMAS WALKER UNIT INC

Table of content: (NPI 1295907095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295907095 NPI number — LEE COUNTY RESCUE SQUAD THOMAS WALKER UNIT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE COUNTY RESCUE SQUAD THOMAS WALKER UNIT INC
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:
6
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:
1295907095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-8413
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 PIONEER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24248-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-445-1150
Provider Business Practice Location Address Fax Number:
865-362-3863
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
FLOYD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-445-1150

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  9 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1295907095 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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