Eastern Shore Ambulance Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

535 Issued in VA

Legal business name

EASTERN SHORE AMBULANCE INC

Practice address

3301 Airline Blvd
Portsmouth, VA 23701-2661

Phone

(866) 343-7153

Fax

(757) 787-9436

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Thomas Ellis

Title

Ar Manager

Phone

(866) 343-7153

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Eastern Shore Ambulance Service Inc Doing business as

Locations

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1205863453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538194",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303538194",
            "telephone_number": "866-343-7153",
            "fax_number": "757-787-9436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012661",
            "telephone_number": "866-343-7153",
            "fax_number": "757-787-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "AR MANAGER",
        "authorized_official_telephone_number": "866-343-7153",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "VA",
            "license": "535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002472",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER NUMB",
            "identifier": "098503",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VETRI PROVIDER NUMBER",
            "identifier": "13616",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590012982",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Shore Ambulance Service Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sean Dyreng, DMD
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• Eckerd Corporation

• Land Ambulance in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Land Ambulance in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.