Waverly Rescue Squad, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

WAVERLY RESCUE SQUAD, INC

Practice address

115 Bank Street
Waverly, VA 23890

Phone

(804) 834-2835

Fax

(804) 834-3116

NPI assigned

Sep 10, 2010

Organization subpart

No

Name

Bonita Meyers

Title

Treasurer

Phone

(407) 463-3087

Organizations that report the same tax identification number in the National Provider Directory.

• Waverly Volunteer Rescue Squad

  • Land Ambulance
  • Waverly, VA
  • NPI 1407089592
  NPD tax ID

Medicare fee-for-service enrollment

Enrolled in VA

Tax ID family

Waverly Rescue Squad Inc (2 organizations share this tax ID)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 11, 2021.

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1487961447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9150",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420029150",
            "telephone_number": "270-744-8413",
            "fax_number": "270-744-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BANK STREET",
            "city": "WAVERLY",
            "state": "VA",
            "postal_code": "23890",
            "telephone_number": "804-834-2835",
            "fax_number": "804-834-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY RESCUE SQUAD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-10",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "BONITA",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "407-463-3087"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL - FECA/ BL/ ENERGY",
            "identifier": "710485000",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487961447",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlotte Nicole Taylor
• Tiny Seeds LLC
• Benjamin Tabiolo Ulep, MD
• Waverly Operating LLC
• Waverly Pharmacy LLC
• Waverly VA Opco LLC
• Waverly Volunteer Rescue Squad
• Sabrina Wells, DDS

• All providers in Waverly, VA
• Land Ambulance in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.