MEDICARE: BLOUNT'S LEGACY TRANSPORTATION

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1871119206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOUNT'S LEGACY TRANSPORTATION

Provider Business Mailing Address
First Line	:	3721 COLONIAL TRL E
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-2311
Country	:	US
Telephone Number	:	757-377-0172
Fax Number	:

Provider Business Practice Location Address
First Line	:	3721 COLONIAL TRL E
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-2311
Country	:	US
Telephone Number	:	757-524-2538
Fax Number	:	757-294-3459

Authorized Official
Title or Position	:	GENERAL PARTNERSHIP
Name	:	MS. JUDY MEEKINS
Credential	:
Telephone Number	:	757-377-0172

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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Practice Location Address:

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