Provider Demographics
NPI:1376597583
Name:DINWIDDIE COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:DINWIDDIE COUNTY BOARD OF SUPERVISORS
Other - Org Name:DINWIDDIE DEPT OF PUBLIC SAFETY
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-469-4500
Mailing Address - Street 1:PO DRAWER 70
Mailing Address - Street 2:14016 BOYDTON PLANK ROAD
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841
Mailing Address - Country:US
Mailing Address - Phone:804-469-5355
Mailing Address - Fax:804-469-7663
Practice Address - Street 1:14016 BOYDTON PLANK ROAD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841
Practice Address - Country:US
Practice Address - Phone:804-469-5388
Practice Address - Fax:804-469-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA785341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA62979OtherOPTIMA
VA100768OtherANTHEM
VAP00078588OtherRR M/CARE
VA62979OtherOPTIMA