Provider Demographics
NPI:1851481170
Name:ANDALUSIA RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:ANDALUSIA RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-222-4155
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1207
Mailing Address - Country:US
Mailing Address - Phone:334-222-4155
Mailing Address - Fax:334-222-0326
Practice Address - Street 1:103 OPP AVE
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3812
Practice Address - Country:US
Practice Address - Phone:334-222-4155
Practice Address - Fax:334-222-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00057127Medicare ID - Type Unspecified