Active NPI
Sandy Ridge Rescue Squad
- Land Ambulance
- Coeburn, VA
National Provider Identifier
1720409246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- SANDY RIDGE RESCUE SQUAD
- Practice address
- 109 Carico RDG
Coeburn, VA 24230-6418 - Phone
- (276) 395-3847
- Fax
- (276) 395-3847
- NPI assigned
- Dec 31, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matthew D Slemp
- Title
- President/Captain
- Phone
- (276) 395-3847
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
109 Carico RDG
Coeburn, VA 24230-6418
Mailing address
PO Box 550
Nora, VA 24272-0550
Phone (276) 395-3847
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 618431700 | Other | VA | FEDERAL BLACK LUNG PROGRAM |
| 1720409246 | Medicaid | VA | |
| 618431700 | Other | VA | DEPARTMENT OF LABOR |
Other names 1
- Sandy Ridge Volunteer Rescue Squad
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140127000919 | VA | Part B Supplier - Ambulance Service Supplier | 5294964011 | Practice locations: Coeburn, VA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388448000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459209600000",
"number": "1720409246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 550",
"city": "NORA",
"state": "VA",
"postal_code": "242720550",
"telephone_number": "276-395-3847",
"fax_number": "276-395-3847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 CARICO RDG",
"city": "COEBURN",
"state": "VA",
"postal_code": "242306418",
"telephone_number": "276-395-3847",
"fax_number": "276-395-3847"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SANDY RIDGE RESCUE SQUAD",
"organizational_subpart": "NO",
"enumeration_date": "2013-12-31",
"last_updated": "2016-03-29",
"status": "A",
"authorized_official_last_name": "SLEMP",
"authorized_official_first_name": "MATTHEW",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PRESIDENT/CAPTAIN",
"authorized_official_telephone_number": "276-395-3847"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG PROGRAM",
"identifier": "618431700",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1720409246",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF LABOR",
"identifier": "618431700",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sandy Ridge Volunteer Rescue Squad",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Coeburn, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.