Polaski County Board of Supervisors

Primary specialty

AmbulanceTaxonomy code 341600000X

License

856 Issued in VA

Legal business name

POLASKI COUNTY BOARD OF SUPERVISORS

Practice address

6580 Valley Center Dr
Ste 118
Fairlawn, VA 24141-5669

Phone

(540) 633-6743

Fax

(540) 633-6745

NPI assigned

Oct 26, 2005

Organization subpart

No

Name

Ms. Mary T Gentile

Title

Authorized Agent

Phone

(860) 257-9201

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 13, 2020.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1508856063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290184",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061290184",
            "telephone_number": "860-257-9201",
            "fax_number": "860-721-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6580 VALLEY CENTER DR",
            "address_2": "STE 118",
            "city": "FAIRLAWN",
            "state": "VA",
            "postal_code": "241415669",
            "telephone_number": "540-633-6743",
            "fax_number": "540-633-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLASKI COUNTY BOARD OF SUPERVISORS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "860-257-9201",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "VA",
            "license": "856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009011293",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590009886",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• New River Economy Drug Inc
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• Whitney Chase Petrie, LCSW
• Juan Polanco, PA-C
• Benjamin Carroll Poovey
• Lisa Pugh, LPC
• Gershon Silber, M.D.
• Stephanie Whited, LCSW LLC
• Jacob Michael Sunderlage, DC

• All providers in Fairlawn, VA
• Ambulance in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.