Organization
CITY OF PETERSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHALEK (CAPTAIN EMS COORDINATOR)
(804) 733-2328
Entity
Organization
Contact information
Practice address
125 N UNION ST, PETERSBURG, VA 23803-3237
(804) 733-2328
Mailing address
103 W TABB ST, PETERSBURG, VA 23803-3211
(804) 733-2328
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
00483
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009014641
—
VA
01
—
465715
ANTHEM
—
Enumeration date
09/13/2006
Last updated
05/29/2013
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