MEDICARE: RURAL RETREAT VOLUNTEER EMERGENCY SERVICES, INC.

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	3416L0300X	Land Ambulance	210	VA

General Provider Information

NPI Number	:	1649509365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL RETREAT VOLUNTEER EMERGENCY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 111
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368-0111
Country	:	US
Telephone Number	:	276-686-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 EAST RAILROAD AVENUE
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368-0000
Country	:	US
Telephone Number	:	276-686-6964
Fax Number	:

Authorized Official
Title or Position	:	CAPTAIN
Name	:	SALLY EARLES
Credential	:
Telephone Number	:	276-686-6964

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	08/10/2021

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