# KILLEN CTR STAR RESCUE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477634459
- **Authorized official:** JAY GOLLIVER (DIRECTOR)
- **Authorized official phone:** (256) 757-5012

## Contact information

- **Practice address:** 207 J C MAULDIN HWY, KILLEN, AL 35645-9146
- **Practice address phone:** (256) 757-5012
- **Mailing address:** PO BOX 365, KILLEN, AL 35645-0365
- **Mailing address phone:** (256) 757-5012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 777 | AL | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 04/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 510-03866 | BLUE CROSS | AL |