Healthcare Provider Details

I. General information

NPI: 1497952535
Provider Name (Legal Business Name): INDEPENDENCE VOLUNTEER RESCUE SQUAD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 WEST MAIN STREET
INDEPENDENCE VA
24348-4365
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-3343
  • Fax: 276-773-3035
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 Number198
License Number StateVA

VIII. Authorized Official

Name: MELAINE O BOYER
Title or Position: CAPTAIN
Credential:
Phone: 276-768-8558