MEDICARE: WICKSBURG FIRE RESCUE

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	422	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-56180	OTHER	AL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1801815196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICKSBURG FIRE RESCUE

Provider Business Mailing Address
First Line	:	1610 ADKINSON ROAD
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352
Country	:	US
Telephone Number	:	334-692-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 ADKINSON RD
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352-8820
Country	:	US
Telephone Number	:	334-692-3866
Fax Number	:

Authorized Official
Title or Position	:	CAPTAIN
Name	:	RAYMOND D SHIVER
Credential	:
Telephone Number	:	334-692-3866

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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Directions to “WICKSBURG FIRE RESCUE ” Practice Location

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