Provider Demographics
NPI:1750145462
Name:ELKIN EMERGENCY RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:ELKIN EMERGENCY RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-835-4101
Mailing Address - Street 1:940 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2404
Mailing Address - Country:US
Mailing Address - Phone:336-835-4101
Mailing Address - Fax:336-946-1768
Practice Address - Street 1:940 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2404
Practice Address - Country:US
Practice Address - Phone:336-835-4101
Practice Address - Fax:336-946-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport