=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861647281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATHEWS VOLUNTEER RESCUE SQUAD INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2008
-----------------------------------------------------
Last Update Date | 04/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94 CRICKET HILL RD.
-----------------------------------------------------
City | HUDGINS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-725-2800
-----------------------------------------------------
Fax | 804-725-1156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 723
-----------------------------------------------------
City | MATHEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23109-0723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-725-2800
-----------------------------------------------------
Fax | 804-725-1156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | MR. DAVID HOWARD BURNS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-725-9063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 00295
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------