Town of Pennington Gap

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

TOWN OF PENNINGTON GAP

Practice address

296 N Kentucky St
Pennington Gap, VA 24277-2226

Phone

(276) 546-1177

Fax

(276) 546-6328

NPI assigned

Oct 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Destiny Van Metre

Title

Manager

Phone

(270) 744-8413

Specialties & licenses 1

Addresses

Other names 1

• Town of Pennington Gap Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1114642428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 INDUSTRIAL DR",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242771612",
            "telephone_number": "276-546-1177",
            "fax_number": "276-546-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 N KENTUCKY ST",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242772226",
            "telephone_number": "276-546-1177",
            "fax_number": "276-546-6328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF PENNINGTON GAP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "VAN METRE",
        "authorized_official_first_name": "DESTINY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "270-744-8413",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Town of Pennington Gap",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Town of Pennington Gap",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kala Rutherford Stapleton
• Gregory Ray Stewart, R.PH.
• Valerie Renee Taylor, PTA
• Winston Joshua Terry
• The Carson Black Lung Research and Education Center
• Chanda Varandani, MD
• Jai K Varandani, MD
• Walgreen Co
• Wellmont Health System
• Wellmont Health System

• Land Ambulance in Pennington Gap, VA
• Providers in Pennington Gap, VA by specialty
• Land Ambulance in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.