MEDICARE: LEAD MINES RESCUE SQUAD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336445766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAD MINES RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-4864

Provider Business Practice Location Address
First Line	:	1057 FORT CHISWELL RD
Second Line	:
City	:	MAX MEADOWS
State	:	VA
Zip	:	24360-3004
Country	:	US
Telephone Number	:	276-764-2101
Fax Number	:	276-764-2102

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	CODY JACKSON
Credential	:
Telephone Number	:	276-620-8916

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	03/01/2021

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Directions to “LEAD MINES RESCUE SQUAD INC ” Practice Location

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