Provider Demographics
NPI:1790920684
Name:TAPPAHANNOCK RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:TAPPAHANNOCK RESCUE SQUAD, INC
Other - Org Name:TAPPAHANNOCK VOLUNTEER RESCUE SQUAD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-443-2166
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-0583
Mailing Address - Country:US
Mailing Address - Phone:804-443-2166
Mailing Address - Fax:804-445-8877
Practice Address - Street 1:303 DUKE ST
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-2166
Practice Address - Fax:804-445-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190002088Medicare PIN