Organization
JEB STUART RESCUE SQUAD INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY WILLARD (PRESIDENT)
(276) 229-6272
Entity
Organization
Contact information
Practice address
1258 AMERICAN LEGION RD, STUART, VA 24171
(276) 694-6171
(276) 694-5366
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(860) 257-7080
(860) 563-3403
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
158
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010209196
—
VA
Enumeration date
06/14/2006
Last updated
09/13/2022
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