Provider Demographics
NPI:1437147808
Name:RESCUE SQUAD OF CLIFTON FORGE VA., INC
Entity Type:Organization
Organization Name:RESCUE SQUAD OF CLIFTON FORGE VA., INC
Other - Org Name:CLIFTON FORGE RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-676-4785
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:522 COMMERCIAL AVE.
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422
Practice Address - Country:US
Practice Address - Phone:540-969-9708
Practice Address - Fax:540-862-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA229341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211204Medicaid
VAP00228595OtherRAILROAD MEDICARE
VA188850OtherBLUE CROSS VA
VA188850OtherANTHEM
VA190001319Medicare PIN