Provider Demographics
NPI:1740361609
Name:HALEBURG RESCUE SQUAD INC
Entity type:Organization
Organization Name:HALEBURG RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-794-5400
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-0115
Mailing Address - Country:US
Mailing Address - Phone:334-585-5555
Mailing Address - Fax:334-585-5555
Practice Address - Street 1:10361 GEORGE H GRIMSLEY HWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:AL
Practice Address - Zip Code:36319-5831
Practice Address - Country:US
Practice Address - Phone:334-794-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051551088Medicaid
AL051507349OtherBLUE CROSS BLUE SHIELD AL
AL051551088Medicare PIN