Basic Information
| Provider Information | |||||||||
| NPI: | 1710090014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOTETOURT COUNTY BOARD OF SUPERVISORS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 N ROANOKE ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FINCASTLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240903018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404738401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 05/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | FIRESTONE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMERGENCY SERVICES SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5404738401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 1128 | VA | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 010234107 | 05 | VA | MEDICAID | 181780 | 01 | VA | ANTHEM | OTHER |