Healthcare Provider Details

I. General information

NPI: 1093700742
Provider Name (Legal Business Name): SOUTHSIDE RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W ATLANTIC ST
SOUTH HILL VA
23970-1808
US

IV. Provider business mailing address

PO BOX 660
SOUTH HILL VA
23970-0660
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-5038
  • Fax:
Mailing address:
  • Phone: 434-447-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FLOYD EDMONDS
Title or Position: TREASURER
Credential:
Phone: 434-447-5038