Provider Demographics
NPI:1689928129
Name:GOOCHLAND COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:GOOCHLAND COUNTY BOARD OF SUPERVISORS
Other - Org Name:GOOCHLAND COUNTY FIRE-RESCUE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE-RESCUE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DILLARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-556-5304
Mailing Address - Street 1:PO BOX 715724
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5724
Mailing Address - Country:US
Mailing Address - Phone:804-556-5304
Mailing Address - Fax:804-556-2623
Practice Address - Street 1:2938 RIVER RD W
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3229
Practice Address - Country:US
Practice Address - Phone:804-556-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA597341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01163288OtherRAILROAD MEDICARE
VAP01163288OtherRAILROAD MEDICARE