Provider Demographics
NPI:1740428960
Name:SHENANDOAH RESCUE SQUAD INC
Entity Type:Organization
Organization Name:SHENANDOAH RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-731-5464
Mailing Address - Street 1:544 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:VA
Mailing Address - Zip Code:22849-1613
Mailing Address - Country:US
Mailing Address - Phone:877-731-5464
Mailing Address - Fax:800-234-1627
Practice Address - Street 1:544 4TH ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:VA
Practice Address - Zip Code:22849-1613
Practice Address - Country:US
Practice Address - Phone:877-731-5464
Practice Address - Fax:800-234-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAEMS AGENCY # 249341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740428960Medicaid
VA973882OtherSOUTHERN HEALTH SERVICES
VA8364743OtherAMTHEM
VA1740428960Medicaid
VA973882OtherSOUTHERN HEALTH SERVICES