Provider Demographics
NPI:1053380212
Name:DICKENSON COUNTY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:DICKENSON COUNTY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DIENNE
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-644-4987
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:142 MAIN ST
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228
Mailing Address - Country:US
Mailing Address - Phone:276-926-8896
Mailing Address - Fax:276-926-6915
Practice Address - Street 1:142 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-926-8896
Practice Address - Fax:276-926-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
086827500OtherDEPARTMENT OF LABOR
5524457OtherAETNA
VA009002081Medicaid
VA009002081Medicaid