=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659392975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIORITY 1 AMBULANCE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3819 HENDRICKS RD
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-7334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-639-9112
-----------------------------------------------------
Fax | 804-674-5968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4098
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-7334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-639-9112
-----------------------------------------------------
Fax | 804-674-5968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CYNTHIA W DIXON
-----------------------------------------------------
Credential | OWNER-GROUND AMBULAN
-----------------------------------------------------
Telephone | 804-639-9112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1226
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------