Provider Demographics
NPI:1114642428
Name:TOWN OF PENNINGTON GAP
Entity Type:Organization
Organization Name:TOWN OF PENNINGTON GAP
Other - Org Name:TOWN OF PENNINGTON GAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN METRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-744-8413
Mailing Address - Street 1:528 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-1612
Mailing Address - Country:US
Mailing Address - Phone:276-546-1177
Mailing Address - Fax:276-546-6328
Practice Address - Street 1:296 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2226
Practice Address - Country:US
Practice Address - Phone:276-546-1177
Practice Address - Fax:276-546-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport