Provider Demographics
NPI:1073713137
Name:RIDGEWAY DISTRICT RESCUE SQUAD INC.
Entity Type:Organization
Organization Name:RIDGEWAY DISTRICT RESCUE SQUAD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-226-0409
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-0611
Mailing Address - Country:US
Mailing Address - Phone:276-956-5889
Mailing Address - Fax:276-292-2910
Practice Address - Street 1:108 MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-0611
Practice Address - Country:US
Practice Address - Phone:276-956-5889
Practice Address - Fax:276-292-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA331341600000X
VA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
190001974Medicare PIN