1992706725 NPI number — GALAX GRAYSON EMERGENCY MEDICAL SERVICES

Table of content: (NPI 1992706725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992706725 NPI number — GALAX GRAYSON EMERGENCY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALAX GRAYSON EMERGENCY MEDICAL SERVICES
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:
CITY OF GALAX DBA GALAX GRAYSON EMS
Provider Other Organization Name Type Code:
3
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:
1992706725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E GRAYSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24333-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-236-3441
Provider Business Mailing Address Fax Number:
276-236-4640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 W OLDTOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24333-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-236-3441
Provider Business Practice Location Address Fax Number:
276-236-4640
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PASSMORE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF OF EMS
Authorized Official Telephone Number:
276-236-3441

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  00196 , 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: 009001352 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 096167 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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