| Name | Value |
|---|---|
| PROVIDER TYPE | Emergency Medical Service |
| CLASSIFICATION | First Responder (lower skill level) |
| STATUS | Inactive |
| DATE INACTIVATED | 1998-10-20 00:00:00 |
| VA CODE | V050400 |
| reserved | A, Try V05---- |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252570 |
| EFFECTIVE DATE/TIME |
|