Healthcare Provider Details

I. General information

NPI: 1437215704
Provider Name (Legal Business Name): APPOMATTOX COUNTY RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 CONFEDERATE BLVD
APPOMATTOX VA
24522
US

IV. Provider business mailing address

PO BOX 57 763 CONFEDERATE BLVD
APPOMATTOX VA
24522-0057
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-5332
  • Fax:
Mailing address:
  • Phone: 434-352-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. SUSAN G WALTON
Title or Position: PRESIDENT
Credential:
Phone: 434-665-1385