Provider Demographics
NPI:1780678615
Name:MARION COUNTY RESCUE SQUAD INC
Entity Type:Organization
Organization Name:MARION COUNTY RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-363-6246
Mailing Address - Street 1:400 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2749
Mailing Address - Country:US
Mailing Address - Phone:304-363-6246
Mailing Address - Fax:304-363-0667
Practice Address - Street 1:400 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2749
Practice Address - Country:US
Practice Address - Phone:304-363-6246
Practice Address - Fax:304-363-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145367000Medicaid
WV9119501Medicare PIN