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General NPI Number Information
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NPI Number | 1487961447
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Entity Type | Organization
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Legal Business Name | WAVERLY RESCUE SQUAD, INC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 115 BANK STREET
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City | WAVERLY
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State | VA
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Zip | 23890
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Country | US
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Telephone | 804-834-2835
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Fax | 804-834-3116
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Provider Business Mailing Address
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Address Line | PO BOX 9150
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City | PADUCAH
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State | KY
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Zip | 42002-9150
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Country | US
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Telephone | 270-744-8413
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Fax | 270-744-8642
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Authorized Official
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Title or Position | TREASURER
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Name | BONITA MEYERS
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Credential |
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Telephone | 407-463-3087
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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 | VA
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