Provider Demographics
NPI:1164561601
Name:ALLEN'S AMBULANCE
Entity Type:Organization
Organization Name:ALLEN'S AMBULANCE
Other - Org Name:ALLENS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:SUPERVISOR
Authorized Official - Phone:434-983-3170
Mailing Address - Street 1:4731 BELL RD
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936
Mailing Address - Country:US
Mailing Address - Phone:434-988-3170
Mailing Address - Fax:434-983-1945
Practice Address - Street 1:4731 BELL RD
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936
Practice Address - Country:US
Practice Address - Phone:434-988-3170
Practice Address - Fax:434-983-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009067426Medicaid
VA009067426Medicaid