Healthcare Provider Details

I. General information

NPI: 1053380212
Provider Name (Legal Business Name): DICKENSON COUNTY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MAIN ST
CLINTWOOD VA
24228
US

IV. Provider business mailing address

PO BOX 1441 142 MAIN ST
CLINTWOOD VA
24228
US

V. Phone/Fax

Practice location:
  • Phone: 276-926-8896
  • Fax: 276-926-6915
Mailing address:
  • Phone: 276-926-8896
  • Fax: 276-926-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number18
License Number StateVA

VIII. Authorized Official

Name: ELIZABETH DIENNE MCNUTT
Title or Position: PRESIDENT
Credential:
Phone: 276-644-4987