Provider Demographics
NPI:1053325902
Name:MCINTOSH RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:MCINTOSH RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-944-2590
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:111 RIVER ROAD
Mailing Address - City:MC INTOSH
Mailing Address - State:AL
Mailing Address - Zip Code:36553-0477
Mailing Address - Country:US
Mailing Address - Phone:251-944-2590
Mailing Address - Fax:251-944-8226
Practice Address - Street 1:111 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MC INTOSH
Practice Address - State:AL
Practice Address - Zip Code:36553-0477
Practice Address - Country:US
Practice Address - Phone:251-944-2590
Practice Address - Fax:251-944-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL302341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51053507OtherBLUE CROSS BLUE SHIELD