Provider Demographics
NPI:1336330539
Name:KING GEORGE COUNTY
Entity Type:Organization
Organization Name:KING GEORGE COUNTY
Other - Org Name:KING GEORGE CO DEPT OF EMERGENCY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-775-8910
Mailing Address - Street 1:8122 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-7051
Mailing Address - Country:US
Mailing Address - Phone:540-775-9181
Mailing Address - Fax:540-775-9060
Practice Address - Street 1:10459 COURTHOUSE DR
Practice Address - Street 2:STE 200
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3865
Practice Address - Country:US
Practice Address - Phone:540-775-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1013341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance