Provider Demographics
NPI:1255853016
Name:ELK CREEK RESCUE SQUAD INC
Entity Type:Organization
Organization Name:ELK CREEK RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-655-4240
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ELK CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24326-0130
Mailing Address - Country:US
Mailing Address - Phone:276-655-4240
Mailing Address - Fax:276-655-4936
Practice Address - Street 1:9109 ELK CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:ELK CREEK
Practice Address - State:VA
Practice Address - Zip Code:24326
Practice Address - Country:US
Practice Address - Phone:276-655-4240
Practice Address - Fax:276-655-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA684341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance