Provider Demographics
NPI:1144323478
Name:BLAND COUNTY VOLUNTEER RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:BLAND COUNTY VOLUNTEER RESCUE SQUAD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LIEUTENANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-688-4708
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:BLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24315-0585
Mailing Address - Country:US
Mailing Address - Phone:276-688-4708
Mailing Address - Fax:
Practice Address - Street 1:67 ORCHARD VIEW LANE
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-0585
Practice Address - Country:US
Practice Address - Phone:276-688-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANO NUMBER ON LICENSE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9000069000Medicaid
VA009014462Medicaid
VA009014462Medicaid