Healthcare Provider Details

I. General information

NPI: 1487594040
Provider Name (Legal Business Name): TAC MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12467 IONA SOUND DR
BRISTOW VA
20136-3030
US

IV. Provider business mailing address

8667 RUBY RISE PL
BRISTOW VA
20136-2301
US

V. Phone/Fax

Practice location:
  • Phone: 571-220-1894
  • Fax:
Mailing address:
  • Phone: 571-220-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JAMES GALLANT
Title or Position: OWNER/PARTNER
Credential:
Phone: 571-220-1894