Provider Demographics
NPI:1164647608
Name:BEDFORD COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:BEDFORD COUNTY BOARD OF SUPERVISORS
Other - Org Name:BEDFORD COUNTY FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWLES
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:540-587-0700
Mailing Address - Street 1:1305 FALLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3935
Mailing Address - Country:US
Mailing Address - Phone:540-587-0700
Mailing Address - Fax:540-586-2176
Practice Address - Street 1:1305 FALLING CREEK RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3935
Practice Address - Country:US
Practice Address - Phone:540-587-0700
Practice Address - Fax:540-586-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11973416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA305561OtherANTHEM BCBS
VA1164647608Medicaid
VA=========OtherTRICARE