Organization
JEFFERSONVILLE VOLUNTEER RESCUE SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH A WAYCASTER (AUTHORIZED AGENT)
(304) 253-1059
Entity
Organization
Contact information
Practice address
407 STEELES LANE, TAZEWELL, VA 24651-9625
(276) 988-9062
(276) 988-9062
Mailing address
PO BOX 999, OCEANA, WV 24870-0999
(800) 635-7577
(304) 253-1965
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
892
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558471664
—
VA
05
—
3810012977
—
WV
01
—
P00605846
RAILROAD MEDICARE
VA
Enumeration date
08/30/2006
Last updated
10/09/2012
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