Provider Demographics
NPI:1922031061
Name:BLUEFIELD RESCUE SQUAD INC
Entity Type:Organization
Organization Name:BLUEFIELD RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-325-9471
Mailing Address - Street 1:1900 STADIUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0311
Mailing Address - Country:US
Mailing Address - Phone:304-325-8367
Mailing Address - Fax:304-325-7149
Practice Address - Street 1:1900 STADIUM DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3324
Practice Address - Country:US
Practice Address - Phone:304-325-8367
Practice Address - Fax:304-325-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000207787OtherBLUE CROSS
WV0145962000Medicaid
GA590002781Medicare PIN
OH9213611Medicare PIN