Healthcare Provider Details

I. General information

NPI: 1225321805
Provider Name (Legal Business Name): LOWER KING AND QUEEN COUNTY VOLUNTEER FIRE DEPARTMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BOHANNON PARK
SHACKLEFORDS VA
23156
US

IV. Provider business mailing address

PO BOX 119
MATTAPONI VA
23110-0119
US

V. Phone/Fax

Practice location:
  • Phone: 804-366-2657
  • Fax: 804-785-9411
Mailing address:
  • Phone: 804-366-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1299
License Number StateVA

VIII. Authorized Official

Name: ROBERT COGGSDALE
Title or Position: EMS CHIEF
Credential:
Phone: 804-366-2657