Healthcare Provider Details

I. General information

NPI: 1215226626
Provider Name (Legal Business Name): STEPHENS CITY FIRE AND RESCUE COMPANY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 MULBERRY ST
STEPHENS CITY VA
22655-0253
US

IV. Provider business mailing address

PO BOX 253
STEPHENS CITY VA
22655-0253
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-4576
  • Fax: 540-869-6784
Mailing address:
  • Phone: 540-869-4576
  • Fax: 540-869-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number530
License Number StateVA

VIII. Authorized Official

Name: GREGORY L LOCKE
Title or Position: CHIEF
Credential: M.A.
Phone: 540-896-4576