Provider Demographics
NPI:1134124431
Name:RICHMOND AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:RICHMOND AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-254-1150
Mailing Address - Street 1:2400 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1310
Mailing Address - Country:US
Mailing Address - Phone:804-254-1150
Mailing Address - Fax:804-254-1149
Practice Address - Street 1:2400 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1310
Practice Address - Country:US
Practice Address - Phone:804-254-1150
Practice Address - Fax:804-254-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009000259Medicaid
VA067583OtherANTHEM BLUE CROSS BLUE SH
VA590005592OtherRAILROAD MEDICARE
VA590000088Medicare ID - Type UnspecifiedMEDICARE ID NUMBER