Healthcare Provider Details

I. General information

NPI: 1871240523
Provider Name (Legal Business Name): INCARNATE AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 CROSSED TALONS RD
WOODBRIDGE VA
22193-5797
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 703-597-6529
  • Fax:
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ABENA FYNN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-597-6529