Provider Demographics
NPI:1992706725
Name:GALAX GRAYSON EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:GALAX GRAYSON EMERGENCY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:276-236-3441
Mailing Address - Street 1:111 E GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2903
Mailing Address - Country:US
Mailing Address - Phone:276-236-3441
Mailing Address - Fax:276-236-4640
Practice Address - Street 1:305 W OLDTOWN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3821
Practice Address - Country:US
Practice Address - Phone:276-236-3441
Practice Address - Fax:276-236-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009001352Medicaid
VA096167OtherANTHEM BC/BS
VA096167OtherANTHEM BC/BS