Healthcare Provider Details

I. General information

NPI: 1093736258
Provider Name (Legal Business Name): FIELDALE-COLLINSVILLE VOLUNTEER RESCUE SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 DANIELS CREEK RD
COLLINSVILLE VA
24078-2932
US

IV. Provider business mailing address

PO BOX 760
COLLINSVILLE VA
24078-0760
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-4836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateVA

VIII. Authorized Official

Name: STUART BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 276-673-1354