Healthcare Provider Details

I. General information

NPI: 1902153554
Provider Name (Legal Business Name): 1ST RESPONSE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 THOMAS JEFFERSON HIGHWAY
CULLEN VA
23934
US

IV. Provider business mailing address

4600 THOMAS JEFFERSON HIGHWAY
CULLEN VA
23934
US

V. Phone/Fax

Practice location:
  • Phone: 434-547-9814
  • Fax:
Mailing address:
  • Phone: 434-547-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT E DIXON II
Title or Position: MEMBER
Credential:
Phone: 434-547-9814