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General NPI Number Information
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NPI Number | 1578520318
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Entity Type | Organization
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Legal Business Name | LEFT BEAVER CIVIL DEFENSE & RESCUE SQUAD, INC.
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 15990 KY HWY 122
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City | HI HAT
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State | KY
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Zip | 41636
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Country | US
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Telephone | 606-377-6643
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Fax | 606-377-2888
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | MCDOWELL
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State | KY
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Zip | 41647
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Country | US
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Telephone | 606-377-6643
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Fax | 606-377-2888
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | MR. SHANNON TODD HALL
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Credential |
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Telephone | 606-377-6643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1403
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License Number State | KY
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