1902867906 NPI number — RESCUE 33 AMBULANCE SERVICE INC

Table of content: (NPI 1902867906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902867906 NPI number — RESCUE 33 AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESCUE 33 AMBULANCE SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902867906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MABSCOTT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25871-0911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-575-2866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RESCUE 33 AMBULANCE
Provider Second Line Business Practice Location Address:
1058 ALMARINE DRIVE
Provider Business Practice Location Address City Name:
GRUNDY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-935-4911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUBER
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
276-935-4911

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1142 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 287558 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8040019-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9011919 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".