Healthcare Provider Details

I. General information

NPI: 1710952460
Provider Name (Legal Business Name): BRISTOL LIFE SAVING CREW INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 EUCLID AVE
BRISTOL VA
24201-3733
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 276-669-5441
  • Fax: 276-466-4845
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number437
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: CURTIS MINK
Title or Position: DIRECTOR
Credential:
Phone: 276-669-5441