MEDICARE: RICHMOND AMBULANCE AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	579	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590005592	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	067583	OTHER	VA	ANTHEM BLUE CROSS BLUE SH

General Provider Information

NPI Number	:	1134124431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND AMBULANCE AUTHORITY

Provider Business Mailing Address
First Line	:	2400 HERMITAGE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-1310
Country	:	US
Telephone Number	:	804-254-1150
Fax Number	:	804-254-1149

Provider Business Practice Location Address
First Line	:	2400 HERMITAGE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-1310
Country	:	US
Telephone Number	:	804-254-1150
Fax Number	:	804-254-1149

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICHARD HENRY DECKER III
Credential	:
Telephone Number	:	804-254-1150

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/27/2013

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Directions to “RICHMOND AMBULANCE AUTHORITY ” Practice Location

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