Organization
EASTERN SHORE AMBULANCE INC
Active
Other names
Eastern Shore Ambulance Service Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW THOMAS ELLIS (AR MANAGER)
(866) 343-7153
Entity
Organization
Contact information
Practice address
3301 AIRLINE BLVD, PORTSMOUTH, VA 23701-2661
(866) 343-7153
(757) 787-9436
Mailing address
PO BOX 538194, ATLANTA, GA 30353-8194
(866) 343-7153
(757) 787-9436
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
535
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098503
ANTHEM BCBS PROVIDER NUMB
VA
01
—
13616
VETRI PROVIDER NUMBER
VA
01
—
590012982
RAILROAD MEDICARE
VA
05
—
9002472
—
VA
Enumeration date
06/26/2006
Last updated
08/28/2012
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