MEDICARE: SURRY VOLUNTEER RESCUE SQUAD, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	302	VA

General Provider Information

NPI Number	:	1225373954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURRY VOLUNTEER RESCUE SQUAD, INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-0188
Country	:	US
Telephone Number	:	757-294-5264
Fax Number	:	757-294-5486

Provider Business Practice Location Address
First Line	:	11627 ROLFE HIGHWAY
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883
Country	:	US
Telephone Number	:	757-294-5264
Fax Number	:	757-294-5486

Authorized Official
Title or Position	:	CAPTAIN
Name	:	JENNIFER GWALTNEY
Credential	:
Telephone Number	:	757-294-5264

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	11/20/2017

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