Healthcare Provider Details

I. General information

NPI: 1740361609
Provider Name (Legal Business Name): HALEBURG RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10361 GEORGE H GRIMSLEY HWY
COLUMBIA AL
36319-5831
US

IV. Provider business mailing address

PO BOX 115
HEADLAND AL
36345-0115
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-5400
  • Fax:
Mailing address:
  • Phone: 334-585-5555
  • Fax: 334-585-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number836
License Number StateAL

VIII. Authorized Official

Name: ED ANDERSON
Title or Position: DIRECTOR
Credential:
Phone: 334-794-5400