Provider Demographics
NPI:1093765976
Name:PRINCE EDWARD VOLUNTEER RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:PRINCE EDWARD VOLUNTEER RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:WAGSTAFF
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:434-392-6973
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:434-392-6973
Mailing Address - Fax:434-392-7525
Practice Address - Street 1:500 DOSWELL ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-6973
Practice Address - Fax:434-392-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA170341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009012061Medicaid
VA432775OtherANTHEM
VA34725OtherOPTIMA
VA590014004OtherRR M CARE