Organization
SOUTHAMPTON COUNTY BOARD OF SUPERVISORS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN S THROWER (COUNTY ADMINISTRATOR)
(757) 653-3015
Entity
Organization
Contact information
Practice address
25436 BRIDGE ST, COURTLAND, VA 23837-0000
(757) 653-9221
(757) 653-9711
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
321
VA
3416L0300X
Land Ambulance
Primary
322
VA
3416L0300X
Land Ambulance
323
VA
3416L0300X
Land Ambulance
324
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679564421
—
VA
01
—
188300
ANTHEM
—
01
—
710804800
DOL
VA
Enumeration date
11/01/2005
Last updated
06/15/2022
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