Provider Demographics
NPI:1104814508
Name:THE ROANOKE VALLEY RESCUE SQUAD, INC
Entity type:Organization
Organization Name:THE ROANOKE VALLEY RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-7181
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0863
Mailing Address - Country:US
Mailing Address - Phone:800-948-7991
Mailing Address - Fax:336-766-1279
Practice Address - Street 1:201 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2026
Practice Address - Country:US
Practice Address - Phone:252-537-7181
Practice Address - Fax:252-537-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590011949OtherRAILROAD MEDICARE
NC3406653Medicaid
590011949OtherRAILROAD MEDICARE