Healthcare Provider Details

I. General information

NPI: 1861441073
Provider Name (Legal Business Name): BOYDTON LIFE STATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MADISON ST
BOYDTON VA
23917-3102
US

IV. Provider business mailing address

PO BOX 182
BOYDTON VA
23917
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-6896
  • Fax: 434-738-6896
Mailing address:
  • Phone: 434-738-6896
  • Fax: 434-738-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number553
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN EMIT TOONE
Title or Position: CAPTAIN
Credential:
Phone: 434-738-6896