Provider Demographics
NPI:1205819646
Name:ABINGDON CONVALESCENT AMBULANCE SERVICE INCORPORATED
Entity Type:Organization
Organization Name:ABINGDON CONVALESCENT AMBULANCE SERVICE INCORPORATED
Other - Org Name:ABINGDON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-8470
Mailing Address - Street 1:26165 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7502
Mailing Address - Country:US
Mailing Address - Phone:276-623-8296
Mailing Address - Fax:276-525-1654
Practice Address - Street 1:618 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9699
Practice Address - Country:US
Practice Address - Phone:276-628-8470
Practice Address - Fax:276-623-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA438341600000X
VA17089343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA590936829OtherRAILROAD MEDICARE
VA009001590Medicaid
VA590936829Medicare ID - Type UnspecifiedPROVIDER NUMBER
VA590936829OtherRAILROAD MEDICARE