Healthcare Provider Details

I. General information

NPI: 1134205552
Provider Name (Legal Business Name): DARRYL B. ESTES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MORGAN AVE
PENNINGTON GAP VA
24277-1916
US

IV. Provider business mailing address

PO BOX 760
DRYDEN VA
24243-0760
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-6911
  • Fax:
Mailing address:
  • Phone: 276-546-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1237
License Number StateVA

VIII. Authorized Official

Name: MR. DARRYL BRADLEY ESTES
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 276-546-6911