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General NPI Number Information
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NPI Number | 1568638724
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Entity Type | Organization
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Legal Business Name | PRATER VOLUNTEER RESCUE SQUAD INC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1028 KILLDEER LANE
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City | GRUNDY
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State | VA
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Zip | 24614
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Country | US
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Telephone | 276-597-7173
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Fax | 276-597-7377
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | VANSANT
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State | VA
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Zip | 24656-0145
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Country | US
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Telephone | 276-597-7173
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Fax | 276-597-7377
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Authorized Official
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Title or Position | ASST. CHIEF
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Name | MR. JAMES WESLEY HARRIS
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Credential | PARAMEDIC
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Telephone | 276-202-7600
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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 | 843
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License Number State | VA
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