Healthcare Provider Details

I. General information

NPI: 1386885655
Provider Name (Legal Business Name): CITY OF MANASSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9324 WEST ST STE 103
MANASSAS VA
20110-5158
US

IV. Provider business mailing address

9324 WEST ST SUITE 204
MANASSAS VA
20110-5138
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-8246
  • Fax: 703-257-2403
Mailing address:
  • Phone: 703-257-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1287
License Number StateVA

VIII. Authorized Official

Name: TODD EDWARD LUPTON
Title or Position: BATTALION CHIEF
Credential:
Phone: 703-257-8246