Provider Demographics
NPI:1720607369
Name:VANGUARD AMBULANCE LLC
Entity Type:Organization
Organization Name:VANGUARD AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PEPPERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-640-9429
Mailing Address - Street 1:10712 PRUETT LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4554
Mailing Address - Country:US
Mailing Address - Phone:804-640-9429
Mailing Address - Fax:
Practice Address - Street 1:8417 ERLE RD BAY A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1507
Practice Address - Country:US
Practice Address - Phone:804-814-9150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport