Provider Demographics
NPI:1083994370
Name:RICHARDSON AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:RICHARDSON AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B/RN
Authorized Official - Phone:276-783-4357
Mailing Address - Street 1:1111 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-2367
Mailing Address - Country:US
Mailing Address - Phone:276-783-4357
Mailing Address - Fax:
Practice Address - Street 1:1111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-2367
Practice Address - Country:US
Practice Address - Phone:276-783-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport