Provider Demographics
NPI:1710143532
Name:CARROLL COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:CARROLL COUNTY BOARD OF SUPERVISORS
Other - Org Name:CARROLL COUNTY FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-728-3331
Mailing Address - Street 1:605-1 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343
Mailing Address - Country:US
Mailing Address - Phone:276-730-3006
Mailing Address - Fax:276-730-3193
Practice Address - Street 1:499 FLOYD PIKE HIGHWAY
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-730-3006
Practice Address - Fax:276-730-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00865096OtherRAILROAD MEDICARE
VA1710143532Medicaid
VA190002188OtherMEDICARE PTAN