1740271006 NPI number — FOREST AMBULANCE SERVICE INC

Table of content: (NPI 1740271006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740271006 NPI number — FOREST AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST AMBULANCE SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740271006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/23/2008
NPI Reactivation Date:
05/02/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 28118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23228-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-358-2595
Provider Business Mailing Address Fax Number:
804-358-7662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 NORTHSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23228-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-358-2595
Provider Business Practice Location Address Fax Number:
804-358-7662
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FORREST
Authorized Official First Name:
GEORGINA
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
804-358-7575

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  259 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 259 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009002171 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".