=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134293798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEROKEE RESCUE SQUAD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 01/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8020 HIGHWAY 72
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35616-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-314-5878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 241
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35616-0241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-314-5878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CRYSTAL HUDDLESTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-314-5878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 157
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------