Campbell County Board of Supervisors
Organization Active NPI Land Ambulance · Rustburg, VA
NPI 1205949773 · NPPES record last updated Jun 14, 2023
Key facts
- NPI
- 1205949773
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 1136 (VA)
- Legal business name
- CAMPBELL COUNTY BOARD OF SUPERVISORS
- Practice address
- 34 Communications Lane
Rustburg, VA 24588 - Phone
- (434) 592-9539
- Fax
- (434) 332-9666
- NPI assigned
- Aug 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Tracy M Fairchild
- Title
- Director
- Phone
- (434) 332-9539
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070120000040 | VA | Part B Supplier - Ambulance Service Supplier | 1759382690 | Practice locations: Rustburg, VA; Gladys, VA; Concord, VA; Brookneal, VA |
National Provider Directory
- Tax ID family
- Campbell County Department of Social Services
Locations
1104 Lynchburg Ave
Brookneal, VA 24528
Phone (434) 376-2358
8553 Brookneal Hwy
Gladys, VA 24554
Phone (434) 283-4905
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 1136 | VA | Yes |
Addresses
Primary practice location
34 Communications Lane
Rustburg, VA 24588
Mailing address
PO Box 661046
Dallas, TX 75266-1046
Phone (434) 332-9539
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010348455 | Medicaid | VA | |
| P00378131 | Other | VA | RAILROAD MEDICARE |
| 248041 | Other | VA | ANTHEM |
Other names
- Campbell County Public Safety
Other providers in Rustburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.