Basic Information
| Provider Information | |||||||||
| NPI: | 1811997745 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GILES LIFESAVING & RESCUE SQUAD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045227533 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 WENONAH AVE | ||||||||
| Address2: | |||||||||
| City: | PEARISBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241342285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409214376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 5405991301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 218 | VA | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 590012653 | 01 | VA | RAILROAD MEDICARE | OTHER | 1536242 | 01 | VA | UMWA | OTHER | 281504 | 01 | VA | BLUE CROSS | OTHER | 541852926 | 01 | VA | TRICARE | OTHER | 8002038000 | 05 | WV | MEDICAID | 9011609 | 05 | VA | MEDICAID |