Provider Demographics
NPI:1033205612
Name:SOUTHEAST SHELBY COUNTY EMERGENCY MEDICAL RESCUE INC
Entity Type:Organization
Organization Name:SOUTHEAST SHELBY COUNTY EMERGENCY MEDICAL RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:COBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-669-4866
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0857
Mailing Address - Country:US
Mailing Address - Phone:205-729-3089
Mailing Address - Fax:205-669-4886
Practice Address - Street 1:103 HIGHWAY 47 S
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9464
Practice Address - Country:US
Practice Address - Phone:205-669-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
051530848OtherBLUE CROSS
AL051556446Medicaid
AL051556446Medicaid