MEDICARE: CHASE CITY RESCUE SQUAD, INC.

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	146M00000X	Intermediate Emergency Medical Technician	167	VA
2	146L00000X	Paramedic	167	VA
3	146N00000X	Basic Emergency Medical Technician	167	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00021753	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70772	OTHER	VA	OPTIMA
2	465594	OTHER	VA	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912957929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE CITY RESCUE SQUAD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 81
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924
Country	:	US
Telephone Number	:	434-372-2144
Fax Number	:	434-372-0626

Provider Business Practice Location Address
First Line	:	335 MECKLENBURG DRIVE
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924
Country	:	US
Telephone Number	:	434-372-2144
Fax Number	:	434-372-0626

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CURTIS DODD JONES
Credential	:	EMTI
Telephone Number	:	434-372-2144

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/18/2010

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Directions to “CHASE CITY RESCUE SQUAD, INC. ” Practice Location

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