MEDICARE: ALTAVISTA LIFE SAVING AND FIRST AID CREW, 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	341600000X	Ambulance	126	VA

General Provider Information

NPI Number	:	1598719734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAVISTA LIFE SAVING AND FIRST AID CREW, INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 1
Second Line	:	1510 MAIN STREET
City	:	ALTAVISTA
State	:	VA
Zip	:	24517
Country	:	US
Telephone Number	:	434-369-4716
Fax Number	:	434-369-4306

Provider Business Practice Location Address
First Line	:	1510 MAIN ST
Second Line	:
City	:	ALTAVISTA
State	:	VA
Zip	:	24517
Country	:	US
Telephone Number	:	434-369-4716
Fax Number	:	434-369-4306

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JASON A BRADNER
Credential	:
Telephone Number	:	434-369-4716

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/14/2008

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