Organization
WICKSBURG FIRE RESCUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND D SHIVER (CAPTAIN)
(334) 692-3866
Entity
Organization
Contact information
Practice address
1610 ADKINSON RD, NEWTON, AL 36352-8820
(334) 692-3866
Mailing address
1610 ADKINSON ROAD, NEWTON, AL 36352
(334) 692-3866
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
422
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-56180
BLUE CROSS/BLUE SHIELD
AL
Enumeration date
07/18/2006
Last updated
08/22/2020
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