Healthcare Provider Details

I. General information

NPI: 1013841154
Provider Name (Legal Business Name): ELITE TAC TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BRIDGE ST APT 215
DANVILLE VA
24541-1476
US

IV. Provider business mailing address

545 BRIDGE ST APT 215
DANVILLE VA
24541-1476
US

V. Phone/Fax

Practice location:
  • Phone: 336-329-2162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADRIENE HALL
Title or Position: OWNER
Credential:
Phone: 336-329-2162