Provider Demographics
NPI:1639260094
Name:CITY OF SUFFOLK
Entity Type:Organization
Organization Name:CITY OF SUFFOLK
Other - Org Name:SUFFOLK FIRE & RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-923-4778
Mailing Address - Street 1:PO BOX 1858
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-1858
Mailing Address - Country:US
Mailing Address - Phone:757-923-4778
Mailing Address - Fax:
Practice Address - Street 1:300 KINGS FORK RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7148
Practice Address - Country:US
Practice Address - Phone:757-923-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA741341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001955Medicare PIN