Provider Demographics
NPI:1437168481
Name:PRINCE GEORGE COUNTY
Entity Type:Organization
Organization Name:PRINCE GEORGE COUNTY
Other - Org Name:PRINCE GEORGE FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-722-8720
Mailing Address - Street 1:6602 COURTS DR
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2503
Mailing Address - Country:US
Mailing Address - Phone:804-722-8614
Mailing Address - Fax:804-733-2769
Practice Address - Street 1:6602 COURTS DR
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2503
Practice Address - Country:US
Practice Address - Phone:804-722-8614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010147590Medicaid
VA190001243Medicare PIN