Organization
LEFT BEAVER CIVIL DEFENSE & RESCUE SQUAD, INC.
Active
Organization
LEFT BEAVER CIVIL DEFENSE & RESCUE SQUAD, INC.
Active
Other names
Left Beaver Rescue Squad
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANNON TODD HALL (EMS DIRECTOR)
(606) 377-6643
Entity
Organization
Contact information
Practice address
15990 KY HWY 122, HI HAT, KY 41636
(606) 377-6643
(606) 377-2888
Mailing address
PO BOX 396, MCDOWELL, KY 41647
(606) 377-6643
(606) 377-2888
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1403
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070497
BLUE CROSS BLUE SHIELD
KY
01
—
089857100
BLACK LUNG
KY
01
—
1264125
UNITED MINE WORKERS
KY
05
—
2588650
—
OH
05
—
55036065
—
KY
05
—
56005457
—
KY
01
—
590008357
RAILROAD MEDICARE
KY
Enumeration date
04/26/2006
Last updated
10/14/2010
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