Healthcare Provider Details

I. General information

NPI: 1568481851
Provider Name (Legal Business Name): WYTHE COUNTY RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W SPRING STREET
WYTHEVILLE VA
24382-0389
US

IV. Provider business mailing address

PO BOX 95
PRINCETON WV
24740-0095
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-2671
  • Fax: 276-228-2671
Mailing address:
  • Phone: 866-631-4452
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number000213
License Number StateVA

VIII. Authorized Official

Name: MR. DUSTIN WARF
Title or Position: CAPTAIN
Credential:
Phone: 276-233-1762