Healthcare Provider Details

I. General information

NPI: 1295907095
Provider Name (Legal Business Name): LEE COUNTY RESCUE SQUAD THOMAS WALKER UNIT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 06/09/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PIONEER ROAD
EWING VA
24248-0001
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 276-445-1150
  • Fax: 865-362-3863
Mailing address:
  • Phone: 270-744-8413
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number9
License Number StateVA

VIII. Authorized Official

Name: FLOYD J LONG
Title or Position: PRESIDENT
Credential:
Phone: 276-445-1150