Provider Demographics
NPI:1437449220
Name:LEGACY AMBULANCE LLC
Entity Type:Organization
Organization Name:LEGACY AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-INTERMEDIATE
Authorized Official - Phone:276-971-4407
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:DORAN
Mailing Address - State:VA
Mailing Address - Zip Code:24612-0580
Mailing Address - Country:US
Mailing Address - Phone:276-963-5323
Mailing Address - Fax:276-964-2972
Practice Address - Street 1:5453 GOVERNOR G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:RAVEN
Practice Address - State:VA
Practice Address - Zip Code:24639-9533
Practice Address - Country:US
Practice Address - Phone:276-963-5323
Practice Address - Fax:276-964-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance