Provider Demographics
NPI:1407914856
Name:SKIPPERVILLE VOLUNTEER RESCUE SQUAD
Entity Type:Organization
Organization Name:SKIPPERVILLE VOLUNTEER RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-693-2105
Mailing Address - Street 1:POST OFFICE BOX 149
Mailing Address - Street 2:
Mailing Address - City:SKIPPERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36374-0149
Mailing Address - Country:US
Mailing Address - Phone:866-297-5189
Mailing Address - Fax:
Practice Address - Street 1:POST OFFICE BOX 149
Practice Address - Street 2:
Practice Address - City:SKIPPERVILLE
Practice Address - State:AL
Practice Address - Zip Code:36374-0149
Practice Address - Country:US
Practice Address - Phone:866-297-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL367251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51050017OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL000050017Medicaid
AL51050017OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA