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General NPI Number Information
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NPI Number | 1093700742
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE RESCUE SQUAD INC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 810 W ATLANTIC ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-1808
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Country | US
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Telephone | 434-447-5038
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 660
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City | SOUTH HILL
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State | VA
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Zip | 23970-0660
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Country | US
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Telephone | 434-447-5038
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. FLOYD EDMONDS
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Credential |
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Telephone | 434-447-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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