Provider Demographics
NPI:1518299908
Name:COUNTY OF HENRY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:COUNTY OF HENRY BOARD OF SUPERVISORS
Other - Org Name:HENRY COUNTY DEPARTMENT OF PUBLIC SAFETY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-634-4660
Mailing Address - Street 1:1024 DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1024 DUPONT RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4600
Practice Address - Country:US
Practice Address - Phone:276-634-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA006473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00647OtherVIRGINIA OEMS AGENCY