Healthcare Provider Details

I. General information

NPI: 1245287929
Provider Name (Legal Business Name): AMELIA EMERGENCY SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 OTTERBURN RD
AMELIA VA
23002-4854
US

IV. Provider business mailing address

PO BOX 888
AMELIA VA
23002-0888
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-2339
  • Fax: 804-561-5897
Mailing address:
  • Phone: 804-561-2339
  • Fax: 804-561-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DIANNA M BRYANT
Title or Position: MAL
Credential:
Phone: 804-561-2339