Provider Demographics
NPI:1679564421
Name:SOUTHAMPTON COUNTY BOARD OF SUPERVISORS
Entity type:Organization
Organization Name:SOUTHAMPTON COUNTY BOARD OF SUPERVISORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THROWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-653-3015
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:25436 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:VA
Practice Address - Zip Code:23837-0000
Practice Address - Country:US
Practice Address - Phone:757-653-9221
Practice Address - Fax:757-653-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3223416L0300X
VA3243416L0300X
VA3233416L0300X
VA3213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA710804800OtherDOL
188300OtherANTHEM
VA1679564421Medicaid
VA010195870Medicaid
VA010195926Medicaid
VA010195926Medicaid
VA010195926Medicaid
188300OtherANTHEM