MEDICARE: COLONIAL BEACH 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	341600000X	Ambulance	00280	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801817903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL BEACH RESCUE SQUAD INCORPORATED

Provider Business Mailing Address
First Line	:	225 DENNISON ST
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-2311
Country	:	US
Telephone Number	:	804-224-7750
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 DENNISON ST
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-2311
Country	:	US
Telephone Number	:	804-224-7750
Fax Number	:

Authorized Official
Title or Position	:	RESCUE CHIEF
Name	:	RONALD RIDGELY
Credential	:
Telephone Number	:	804-224-7750

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/07/2008

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