MEDICARE: CENTRAL LIFESAVING AND RESCUE SQUAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	164	VA

General Provider Information

NPI Number	:	1528597200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL LIFESAVING AND RESCUE SQUAD

Provider Business Mailing Address
First Line	:	PO BOX 386
Second Line	:
City	:	GASBURG
State	:	VA
Zip	:	23857-0386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5736 GASBURG ROAD
Second Line	:
City	:	GASBURG
State	:	VA
Zip	:	23857-2385
Country	:	US
Telephone Number	:	434-532-6015
Fax Number	:	434-532-6015

Authorized Official
Title or Position	:	CAPTAIN
Name	:	MR. WADE ALLEN RICHARDSON JR.
Credential	:
Telephone Number	:	434-532-6015

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/07/2017

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Directions to “CENTRAL LIFESAVING AND RESCUE SQUAD ” Practice Location

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