Provider Demographics
NPI:1003130188
Name:KING WILLIAM COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:KING WILLIAM COUNTY BOARD OF SUPERVISORS
Other - Org Name:KING WILLIAM COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-769-4961
Mailing Address - Street 1:180 HORSE LANDING ROAD #4
Mailing Address - Street 2:
Mailing Address - City:KING WILLIAM
Mailing Address - State:VA
Mailing Address - Zip Code:23086-3222
Mailing Address - Country:US
Mailing Address - Phone:804-769-4929
Mailing Address - Fax:804-769-4964
Practice Address - Street 1:7936 RICHMOND TAPPAHANNOCK HIGHWAY
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23086-2743
Practice Address - Country:US
Practice Address - Phone:804-769-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1254341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance