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General NPI Number Information
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NPI Number | 1295723658
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Entity Type | Organization
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Legal Business Name | WASHINGTON COUNTY LIFE SAVING CREW INC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 237 PARK ST SE
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City | ABINGDON
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State | VA
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Zip | 24210-3311
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Country | US
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Telephone | 276-676-2401
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Fax | 276-676-2285
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | ABINGDON
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State | VA
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Zip | 24212-0065
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Country | US
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Telephone | 276-608-3941
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Fax | 276-867-6622
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Authorized Official
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Title or Position | TREASURER
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Name | ANISSA MICHELLE GRUBB
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Credential |
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Telephone | 276-608-3941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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