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General NPI Number Information
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NPI Number | 1528163052
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE VIRGINIA EMERGENCY CREW,INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 425 GRAHAM RD
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City | PETERSBURG
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State | VA
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Zip | 23805-1450
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Country | US
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Telephone | 804-861-2739
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Fax | 804-861-4184
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Provider Business Mailing Address
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Address Line | PO BOX 574
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City | PETERSBURG
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State | VA
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Zip | 23804-0574
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Country | US
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Telephone | 804-861-2739
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Fax | 804-861-4184
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | EDWARD BISH JR.
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Credential |
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Telephone | 804-861-2739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 00298
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License Number State | VA
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