Provider Demographics
NPI:1891044749
Name:WOODSTOCK RESCUE SQUAD
Entity Type:Organization
Organization Name:WOODSTOCK RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDKIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-459-4231
Mailing Address - Street 1:132 W RESERVOIR RD
Mailing Address - Street 2:PO BOX 221
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 W RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1012
Practice Address - Country:US
Practice Address - Phone:540-459-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00065341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ414110001Medicare PIN