MEDICARE: IMPULSE TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi

General Provider Information

NPI Number	:	1053919282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPULSE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2119 CLEARFIELD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2809
Country	:	US
Telephone Number	:	804-647-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 CLEARFIELD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224
Country	:	US
Telephone Number	:	804-647-0796
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA T MORRIS
Credential	:
Telephone Number	:	804-647-0796

Provider Enumeration Date	:	10/10/2020
Last Update Date	:	10/10/2020

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Directions to “IMPULSE TRANSPORT LLC ” Practice Location

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