Healthcare Provider Details

I. General information

NPI: 1962470716
Provider Name (Legal Business Name): DALEVILLE VOLUNTEER RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S DALEVILLE AVE
DALEVILLE AL
36322
US

IV. Provider business mailing address

PO BOX 188
DALEVILLE AL
36322
US

V. Phone/Fax

Practice location:
  • Phone: 334-598-4442
  • Fax: 334-598-8670
Mailing address:
  • Phone: 334-598-4442
  • Fax: 334-598-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3416L0300X
License Number StateAL

VIII. Authorized Official

Name: CHARLES G SAPP JR.
Title or Position: BILLING CLERK RECORDS
Credential:
Phone: 334-598-4442