Provider Demographics
NPI:1225373954
Name:SURRY VOLUNTEER RESCUE SQUAD, INCORPORATED
Entity Type:Organization
Organization Name:SURRY VOLUNTEER RESCUE SQUAD, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GWALTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-294-5264
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:VA
Mailing Address - Zip Code:23883-0188
Mailing Address - Country:US
Mailing Address - Phone:757-294-5264
Mailing Address - Fax:757-294-5486
Practice Address - Street 1:11627 ROLFE HIGHWAY
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:VA
Practice Address - Zip Code:23883
Practice Address - Country:US
Practice Address - Phone:757-294-5264
Practice Address - Fax:757-294-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport