Provider Demographics
NPI:1528163052
Name:SOUTHSIDE VIRGINIA EMERGENCY CREW,INC.
Entity type:Organization
Organization Name:SOUTHSIDE VIRGINIA EMERGENCY CREW,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BISH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-861-2739
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23804-0574
Mailing Address - Country:US
Mailing Address - Phone:804-861-2739
Mailing Address - Fax:804-861-4184
Practice Address - Street 1:425 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-1450
Practice Address - Country:US
Practice Address - Phone:804-861-2739
Practice Address - Fax:804-861-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00298341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009011056Medicaid
100625OtherANTHEM
61593OtherSENTARA HEALTH
VA009011056Medicaid