Provider Demographics
NPI:1114090909
Name:CLAY COUNTY RESCUE SQUAD
Entity Type:Organization
Organization Name:CLAY COUNTY RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-396-0445
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-0428
Mailing Address - Country:US
Mailing Address - Phone:256-396-0445
Mailing Address - Fax:256-396-0446
Practice Address - Street 1:453 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266
Practice Address - Country:US
Practice Address - Phone:256-396-0445
Practice Address - Fax:256-396-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51026201OtherBCBS OF ALABAMA