Provider Demographics
NPI:1922135193
Name:EMERGICARE OF HARRISONBURG, INC.
Entity Type:Organization
Organization Name:EMERGICARE OF HARRISONBURG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-432-9996
Mailing Address - Street 1:755A CANTRELL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4366
Mailing Address - Country:US
Mailing Address - Phone:540-432-9996
Mailing Address - Fax:540-432-9997
Practice Address - Street 1:755A CANTRELL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4366
Practice Address - Country:US
Practice Address - Phone:540-432-9996
Practice Address - Fax:540-432-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052985173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005644518Medicaid
VA241633OtherANTHEM
VAC06100Medicare PIN