1205949773 NPI number — CAMPBELL COUNTY BOARD OF SUPERVISORS

Table of content: (NPI 1205949773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205949773 NPI number — CAMPBELL COUNTY BOARD OF SUPERVISORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPBELL COUNTY BOARD OF SUPERVISORS
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:
CAMPBELL COUNTY PUBLIC SAFETY
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:
1205949773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 661046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-332-9539
Provider Business Mailing Address Fax Number:
434-332-2957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 COMMUNICATIONS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-592-9539
Provider Business Practice Location Address Fax Number:
434-332-9666
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRCHILD
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
434-332-9539

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1136 , 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: 010348455 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00378131 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 248041 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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