Provider Demographics
NPI:1184676348
Name:ISLE OF WIGHT CO BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:ISLE OF WIGHT CO BOARD OF SUPERVISORS
Other - Org Name:ISLE OF WIGHT CO EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNTY ADMINISTRATOR ISLE OF WIGHT
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-365-6201
Mailing Address - Street 1:PO BOX 61549
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466
Mailing Address - Country:US
Mailing Address - Phone:800-355-1753
Mailing Address - Fax:757-557-0936
Practice Address - Street 1:17130 MONUMENT CIRCLE
Practice Address - Street 2:
Practice Address - City:ISLE OF WIGHT
Practice Address - State:VA
Practice Address - Zip Code:23397
Practice Address - Country:US
Practice Address - Phone:757-365-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1052341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance