Healthcare Provider Details

I. General information

NPI: 1104814508
Provider Name (Legal Business Name): THE ROANOKE VALLEY RESCUE SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WASHINGTON ST
ROANOKE RAPIDS NC
27870-2026
US

IV. Provider business mailing address

PO BOX 863
LEWISVILLE NC
27023-0863
US

V. Phone/Fax

Practice location:
  • Phone: 252-537-7181
  • Fax: 252-537-6445
Mailing address:
  • Phone: 800-948-7991
  • Fax: 336-766-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1380
License Number StateNC

VIII. Authorized Official

Name: MR. MARK COLLIER
Title or Position: EMS DIRECTOR
Credential:
Phone: 252-537-7181