Healthcare Provider Details

I. General information

NPI: 1679564421
Provider Name (Legal Business Name): SOUTHAMPTON COUNTY BOARD OF SUPERVISORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25436 BRIDGE ST
COURTLAND VA
23837-0000
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-9221
  • Fax: 757-653-9711
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number324
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number323
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number321
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number322
License Number StateVA

VIII. Authorized Official

Name: BRIAN S THROWER
Title or Position: COUNTY ADMINISTRATOR
Credential:
Phone: 757-653-3015