Provider Demographics
NPI:1497705255
Name:KENBRIDGE EMERGENCY SQUAD, INC.
Entity Type:Organization
Organization Name:KENBRIDGE EMERGENCY SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:EDMONDS
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-676-4848
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944
Mailing Address - Country:US
Mailing Address - Phone:434-676-4848
Mailing Address - Fax:434-676-4824
Practice Address - Street 1:915 EAST 5TH AVE
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944
Practice Address - Country:US
Practice Address - Phone:434-676-4848
Practice Address - Fax:434-676-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA94451OtherOPTIMA
VA010201250Medicaid
VAP00224440OtherRR CARE
VA94451OtherOPTIMA