Basic Information
| Provider Information | |||||||||
| NPI: | 1649265604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STERLING EMERGENCY SERVICES OF VIRGINIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 532858 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303532858 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 OAK ST | ||||||||
| Address2: | |||||||||
| City: | FARMVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 239011199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343928811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | RANDY | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9048051300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | DC4071 | 01 | VA | RR MCR GROUP | OTHER | 153395 | 01 | VA | ANTHEM GROUP | OTHER |