Healthcare Provider Details

I. General information

NPI: 1780797159
Provider Name (Legal Business Name): AMELIA AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 EGGLESTETTON RD
AMELIA COURT HOUSE VA
23002-4902
US

IV. Provider business mailing address

16601 EGGLESTETTON RD
AMELIA COURT HOUSE VA
23002-4902
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-7182
  • Fax: 804-561-1658
Mailing address:
  • Phone: 804-561-7182
  • Fax: 804-561-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number862
License Number StateVA

VIII. Authorized Official

Name: MR. RICHARD RUSSELL ALLEY JR.
Title or Position: OPERATIONS MANGER
Credential:
Phone: 804-561-7182