=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679430920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOL BRANCH VOLUNTEER RESCUE SQUAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 SMITH MOUNTAIN ROAD
-----------------------------------------------------
City | PENHOOK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-927-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 54
-----------------------------------------------------
City | PENHOOK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24137-0054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CAPTAIN
-----------------------------------------------------
Name | TIFFANI MATHERLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-927-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------