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General NPI Number Information
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NPI Number | 1922386846
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Entity Type | Organization
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Legal Business Name | MATTAPONI VOLUNTEER RESCUE SQUAD INC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 6089 CATEBURY ROAD
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City | WALKERTON
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State | VA
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Zip | 23177
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Country | US
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Telephone | 804-769-3487
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Fax |
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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 | CHIEF OF OPERATIONS
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Name | TAMMY MASON
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Credential |
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Telephone | 804-937-0764
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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 | 799
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License Number State | VA
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