Provider Demographics
NPI:1235170523
Name:HOPEWELL EMERGENCY CREW
Entity Type:Organization
Organization Name:HOPEWELL EMERGENCY CREW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-458-3866
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-0659
Mailing Address - Country:US
Mailing Address - Phone:804-458-3866
Mailing Address - Fax:804-458-3866
Practice Address - Street 1:102 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-3839
Practice Address - Country:US
Practice Address - Phone:804-458-3866
Practice Address - Fax:804-541-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA72505OtherOPTIMA HEALTH
VA080056400OtherDEPT OF LABOR AND EMPLOYMENT
VA100565OtherBC/BS OF VIRGINIA
VA80056400OtherFEDERAL BLACK LUNG PROGRAM
VA1235170523Medicaid
P00056026Medicare PIN
VA80056400OtherFEDERAL BLACK LUNG PROGRAM