Provider Demographics
NPI:1962571711
Name:BLY RESCUE UNIT INC
Entity type:Organization
Organization Name:BLY RESCUE UNIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LEGAL REP
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:541-882-6984
Mailing Address - Street 1:2261 SOUTH 6TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-6984
Mailing Address - Fax:541-884-7585
Practice Address - Street 1:611378 HIGHWAY 140
Practice Address - Street 2:
Practice Address - City:BLY
Practice Address - State:OR
Practice Address - Zip Code:97622
Practice Address - Country:US
Practice Address - Phone:541-882-6984
Practice Address - Fax:541-884-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORE212835341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance