Provider Demographics
NPI:1235149030
Name:DAVIS AMBULANCE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:DAVIS AMBULANCE ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-223-8807
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0140
Mailing Address - Country:US
Mailing Address - Phone:434-223-8807
Mailing Address - Fax:
Practice Address - Street 1:3987 BACK HAMPDEN SYDNEY RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-5531
Practice Address - Country:US
Practice Address - Phone:434-223-8807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009002201Medicaid
VA094258OtherANTHEM BLUE CROSS
MD4048709 00Medicaid
VA47991OtherOPTIMA FAMILY CARE
VA094258OtherANTHEM BLUE CROSS
VA094258OtherANTHEM BLUE CROSS
VA590003076Medicare ID - Type UnspecifiedRAILROAD MEDICARE