Organization
LEAD MINES RESCUE SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CODY JACKSON (CHAIRMAN)
(276) 620-8916
Entity
Organization
Contact information
Practice address
1057 FORT CHISWELL RD, MAX MEADOWS, VA 24360-3004
(276) 764-2101
(276) 764-2102
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-4864
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336445766
—
VA
Enumeration date
02/02/2011
Last updated
03/01/2021
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