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Organization
KILLEN CTR STAR RESCUE
Active
Organization
KILLEN CTR STAR RESCUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY GOLLIVER (DIRECTOR)
(256) 757-5012
Entity
Organization
Contact information
Practice address
207 J C MAULDIN HWY, KILLEN, AL 35645-9146
(256) 757-5012
Mailing address
PO BOX 365, KILLEN, AL 35645-0365
(256) 757-5012
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
777
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-03866
BLUE CROSS
AL
Enumeration date
10/18/2006
Last updated
04/10/2008
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