Healthcare Provider Details

I. General information

NPI: 1326560947
Provider Name (Legal Business Name): QUALITY CARE LOGISTICS AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 EAST LEE HIGHWAY
MAX MEADOWS VA
24360
US

IV. Provider business mailing address

185 ARROWHEAD LN
WYTHEVILLE VA
24382-5371
US

V. Phone/Fax

Practice location:
  • Phone: 276-613-3316
  • Fax:
Mailing address:
  • Phone: 276-613-3316
  • 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: MATHEW C PORTER
Title or Position: OWNER
Credential:
Phone: 276-613-3316