1083899363 NPI number — MIDATLANTIC REGIONAL AMBULANCE INC

Table of content: (NPI 1083899363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083899363 NPI number — MIDATLANTIC REGIONAL AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDATLANTIC REGIONAL AMBULANCE 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:
1083899363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 896
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23705-0896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-273-7360
Provider Business Mailing Address Fax Number:
757-273-7557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 PROGRESS LANE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-273-7360
Provider Business Practice Location Address Fax Number:
757-273-7557
Provider Enumeration Date:
01/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAUD
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
757-273-7360

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 1282 , 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)





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