Provider Demographics
NPI:1740271006
Name:FOREST AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:FOREST AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-358-7575
Mailing Address - Street 1:P.O. BOX 28118
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-9998
Mailing Address - Country:US
Mailing Address - Phone:804-358-2595
Mailing Address - Fax:804-358-7662
Practice Address - Street 1:3101 NORTHSIDE AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5409
Practice Address - Country:US
Practice Address - Phone:804-358-2595
Practice Address - Fax:804-358-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2015-07-14
Deactivation Date:2008-04-23
Deactivation Code:
Reactivation Date:2008-05-02
Provider Licenses
StateLicense IDTaxonomies
VA259341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009002171Medicaid
VA590000036Medicare PIN