Healthcare Provider Details

I. General information

NPI: 1912957929
Provider Name (Legal Business Name): CHASE CITY RESCUE SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 MECKLENBURG DRIVE
CHASE CITY VA
23924
US

IV. Provider business mailing address

PO BOX 81
CHASE CITY VA
23924
US

V. Phone/Fax

Practice location:
  • Phone: 434-372-2144
  • Fax: 434-372-0626
Mailing address:
  • Phone: 434-372-2144
  • Fax: 434-372-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number167
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number167
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number167
License Number StateVA

VIII. Authorized Official

Name: MR. CURTIS DODD JONES
Title or Position: PRESIDENT
Credential: EMTI
Phone: 434-372-2144