=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235170523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEWELL EMERGENCY CREW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 11/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S 10TH AVE
-----------------------------------------------------
City | HOPEWELL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23860-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-458-3866
-----------------------------------------------------
Fax | 804-541-3561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 659
-----------------------------------------------------
City | HOPEWELL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23860-0659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-458-3866
-----------------------------------------------------
Fax | 804-458-3866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | JERRY A WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-458-3866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------