Provider Demographics
NPI:1467420323
Name:NOTTOWAY COUNTY EMERGENCY SQUAD, INC.
Entity Type:Organization
Organization Name:NOTTOWAY COUNTY EMERGENCY SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-645-7548
Mailing Address - Street 1:501 E VIRGINIA AVE
Mailing Address - Street 2:PO BOX 453
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930-2033
Mailing Address - Country:US
Mailing Address - Phone:434-645-7548
Mailing Address - Fax:434-645-7412
Practice Address - Street 1:501 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930-2033
Practice Address - Country:US
Practice Address - Phone:434-645-7548
Practice Address - Fax:434-645-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9014616Medicaid