=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598901977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL EVENT PROVIDERS OF EMERGENCY MEDICINE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2009
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 DONNA DR SUITE 3
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23451-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-422-4898
-----------------------------------------------------
Fax | 757-422-5707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 68580
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23471-8580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-737-2429
-----------------------------------------------------
Fax | 757-588-3754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT
-----------------------------------------------------
Name | MRS. DIANE MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-737-2429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 2096EV
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------