Provider Demographics
NPI:1083114250
Name:TAZEWELL COUNTY BOARD
Entity Type:Organization
Organization Name:TAZEWELL COUNTY BOARD
Other - Org Name:TAZEWELL COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-385-1200
Mailing Address - Street 1:197 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-6101
Mailing Address - Country:US
Mailing Address - Phone:276-385-1200
Mailing Address - Fax:
Practice Address - Street 1:714 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-1424
Practice Address - Country:US
Practice Address - Phone:276-326-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGMedicaid