Provider Demographics
NPI:1790873107
Name:GENEVA RESCUE SQUAD
Entity Type:Organization
Organization Name:GENEVA RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:334-684-2586
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:AL
Mailing Address - Zip Code:36340-0175
Mailing Address - Country:US
Mailing Address - Phone:334-684-2586
Mailing Address - Fax:334-684-0590
Practice Address - Street 1:517 S COMMERCE ST
Practice Address - Street 2:701 S COMMERCE ST
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-2420
Practice Address - Country:US
Practice Address - Phone:334-684-2586
Practice Address - Fax:334-684-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL02423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-50168OtherBLUE CROSS BLUE SHIELD
AL=========Medicare UPIN