Healthcare Provider Details

I. General information

NPI: 1205949773
Provider Name (Legal Business Name): CAMPBELL COUNTY BOARD OF SUPERVISORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 COMMUNICATIONS LANE
RUSTBURG VA
24588
US

IV. Provider business mailing address

PO BOX 661046
DALLAS TX
75266-1046
US

V. Phone/Fax

Practice location:
  • Phone: 434-592-9539
  • Fax: 434-332-9666
Mailing address:
  • Phone: 434-332-9539
  • Fax: 434-332-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1136
License Number StateVA

VIII. Authorized Official

Name: TRACY M FAIRCHILD
Title or Position: DIRECTOR
Credential:
Phone: 434-332-9539