Provider Demographics
NPI:1801815196
Name:WICKSBURG FIRE RESCUE
Entity type:Organization
Organization Name:WICKSBURG FIRE RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-692-3866
Mailing Address - Street 1:1610 ADKINSON ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352
Mailing Address - Country:US
Mailing Address - Phone:334-692-3866
Mailing Address - Fax:
Practice Address - Street 1:1610 ADKINSON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:AL
Practice Address - Zip Code:36352-8820
Practice Address - Country:US
Practice Address - Phone:334-692-3866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-56180OtherBLUE CROSS/BLUE SHIELD