=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861441073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOYDTON LIFE STATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 MADISON ST
-----------------------------------------------------
City | BOYDTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23917-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-738-6896
-----------------------------------------------------
Fax | 434-738-6896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 182
-----------------------------------------------------
City | BOYDTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-738-6896
-----------------------------------------------------
Fax | 434-738-0577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CAPTAIN
-----------------------------------------------------
Name | MR. JOHN EMIT TOONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-738-6896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 553
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------