Provider Demographics
NPI:1245275403
Name:HANOVER COUNTY BOARD OF SUPERVISORS
Entity type:Organization
Organization Name:HANOVER COUNTY BOARD OF SUPERVISORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JETHRO
Authorized Official - Middle Name:H
Authorized Official - Last Name:PILAND
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-365-6195
Mailing Address - Street 1:PO BOX 715445
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5445
Mailing Address - Country:US
Mailing Address - Phone:804-365-6195
Mailing Address - Fax:804-537-5458
Practice Address - Street 1:13326 HANOVER COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VA
Practice Address - Zip Code:23069
Practice Address - Country:US
Practice Address - Phone:804-365-6195
Practice Address - Fax:804-537-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA779341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010127530Medicaid
VA0000000178983OtherANTHEM
VAP00203980OtherRAILROAD MEDICARE
VA010127530Medicaid