Provider Demographics
NPI:1578044418
Name:CHAMBERS, JERRY MICHAEL SR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:MICHAEL
Last Name:CHAMBERS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14507 LAVENHAM LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1681
Mailing Address - Country:US
Mailing Address - Phone:804-513-2992
Mailing Address - Fax:
Practice Address - Street 1:14507 LAVENHAM LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1681
Practice Address - Country:US
Practice Address - Phone:804-513-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)