Healthcare Provider Details

I. General information

NPI: 1356512206
Provider Name (Legal Business Name): CRAIG COUNTY RESCUE SQUAD EMS- INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 PAINT BANK ROAD
NEW CASTLE VA
24127
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 540-864-5115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number368
License Number StateVA

VIII. Authorized Official

Name: ROBERT WRZOSEK
Title or Position: CHIEF
Credential:
Phone: 540-864-5115