Healthcare Provider Details

I. General information

NPI: 1932271301
Provider Name (Legal Business Name): HIGHLANDS AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W.MAIN STREET
LEBANON VA
24266-3900
US

IV. Provider business mailing address

PO BOX 1017
LEBANON VA
24266
US

V. Phone/Fax

Practice location:
  • Phone: 276-889-5877
  • Fax: 276-889-5799
Mailing address:
  • Phone: 276-889-0600
  • Fax: 276-889-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number948
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON ALLEN SUTHERLAND
Title or Position: OWNER PRESIDENT
Credential:
Phone: 276-889-5877