1932271301 NPI number — HIGHLANDS AMBULANCE SERVICE INC

Table of content: (NPI 1932271301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932271301 NPI number — HIGHLANDS AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS 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:
1932271301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-889-0600
Provider Business Mailing Address Fax Number:
276-889-4666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 W.MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24266-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-889-5877
Provider Business Practice Location Address Fax Number:
276-889-5799
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUTHERLAND
Authorized Official First Name:
JASON
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
276-889-5877

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  948 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 252970 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009012141 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "UMWA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".