MEDICARE: COTTONWOOD AMBULANCE AND 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	190	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-56520	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417982034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD AMBULANCE AND RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	57 GRANGER ST
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320
Country	:	US
Telephone Number	:	334-691-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 GRANGER ST
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320
Country	:	US
Telephone Number	:	334-691-5059
Fax Number	:

Authorized Official
Title or Position	:	CAPTAIN
Name	:	THERESA STRENGTH
Credential	:
Telephone Number	:	334-691-5059

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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