Clay County Rescue Squad
Organization Active NPI Land Ambulance · Lineville, AL
NPI 1114090909 · NPPES record last updated Aug 2, 2007
Key facts
- NPI
- 1114090909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 176 (AL)
- Legal business name
- CLAY COUNTY RESCUE SQUAD
- Practice address
- 453 Taylor Rd
Lineville, AL 36266 - Phone
- (256) 396-0445
- Fax
- (256) 396-0446
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Pete Dwight Ward
- Title
- Director
- Phone
- (256) 396-0445
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070815000301 | AL | Part B Supplier - Ambulance Service Supplier | 2466544887 | Practice locations: Lineville, AL |
National Provider Directory
Locations
453 Taylor Rd
Lineville, AL 36266
Phone (205) 354-4546
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 176 | AL | Yes |
Addresses
Primary practice location
453 Taylor Rd
Lineville, AL 36266
Mailing address
PO Box 428
Ashland, AL 36251-0428
Phone (256) 396-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51026201 | Other | AL | BCBS OF ALABAMA |
Other providers in Lineville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.