Provider Demographics
NPI:1972676799
Name:CITY OF FREDERICKSBURG
Entity Type:Organization
Organization Name:CITY OF FREDERICKSBURG
Other - Org Name:FREDERICKSBURG FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-372-1059
Mailing Address - Street 1:PO BOX 2605
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-6605
Mailing Address - Country:US
Mailing Address - Phone:866-631-4452
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:601 PRINCESS ANNE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5914
Practice Address - Country:US
Practice Address - Phone:540-372-1059
Practice Address - Fax:540-372-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA511341600000X, 3416L0300X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA338899OtherANTHEM
VAP00641039OtherRAILROAD MEDICARE
VA338899OtherANTHEM
VAP00641039OtherRAILROAD MEDICARE