Provider Demographics
NPI:1568481851
Name:WYTHE COUNTY RESCUE SQUAD INC
Entity type:Organization
Organization Name:WYTHE COUNTY RESCUE SQUAD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-233-1762
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0095
Mailing Address - Country:US
Mailing Address - Phone:866-631-4452
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:195 W SPRING STREET
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-0389
Practice Address - Country:US
Practice Address - Phone:276-228-2671
Practice Address - Fax:276-228-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195085OtherBLUECROSS BLUE SHIELD
VAP00452288OtherRAILROAD MEDICARE
VA010241855Medicaid
VA190001417Medicare PIN