Provider Demographics
NPI:1851325351
Name:VIRGINIA LIFELINE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:VIRGINIA LIFELINE AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-336-5402
Mailing Address - Street 1:4396 LOGAN LN
Mailing Address - Street 2:P.O BOX 317
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-2632
Mailing Address - Country:US
Mailing Address - Phone:757-336-5402
Mailing Address - Fax:757-336-5711
Practice Address - Street 1:4396 LOGAN LN
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-2632
Practice Address - Country:US
Practice Address - Phone:757-336-5402
Practice Address - Fax:757-336-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA762341600000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)