Healthcare Provider Details

I. General information

NPI: 1619243136
Provider Name (Legal Business Name): MADISON COUNTY RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 N MAIN STREET
MADISON VA
22727
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 540-948-5353
  • Fax: 540-948-5625
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number254
License Number StateVA

VIII. Authorized Official

Name: STEVE A GRAYSON
Title or Position: PRESIDENT
Credential:
Phone: 540-948-5383