Provider Demographics
NPI:1922403617
Name:MIDDLESEX COUNTY VOLUNTEER SQUAD INC
Entity Type:Organization
Organization Name:MIDDLESEX COUNTY VOLUNTEER SQUAD INC
Other - Org Name:MIDDLESEX COUNTY RESCUE SQUAD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-776-6875
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:DELTAVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23043-0098
Mailing Address - Country:US
Mailing Address - Phone:804-776-6875
Mailing Address - Fax:804-776-0745
Practice Address - Street 1:17684 GENERAL PULLER HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELTAVILLE
Practice Address - State:VA
Practice Address - Zip Code:23043-0098
Practice Address - Country:US
Practice Address - Phone:804-776-6875
Practice Address - Fax:804-776-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922403617Medicaid
VA1922403617Medicaid
VAQ495050001Medicare PIN