Provider Demographics
NPI:1174578702
Name:COUNTY OF CHESTERFIELD VIRGINIA
Entity type:Organization
Organization Name:COUNTY OF CHESTERFIELD VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-717-6096
Mailing Address - Street 1:P.O. BOX 40
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6528
Mailing Address - Country:US
Mailing Address - Phone:804-717-6096
Mailing Address - Fax:804-751-4146
Practice Address - Street 1:6731 MIMMS LOOP
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6528
Practice Address - Country:US
Practice Address - Phone:804-717-6096
Practice Address - Fax:804-751-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA504341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009011218Medicaid
590000203Medicare ID - Type Unspecified