Healthcare Provider Details

I. General information

NPI: 1740703602
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WELLS FARGO LN
MAX MEADOWS VA
24360-3831
US

IV. Provider business mailing address

PO BOX 467
MAX MEADOWS VA
24360-0467
US

V. Phone/Fax

Practice location:
  • Phone: 276-620-7433
  • Fax:
Mailing address:
  • Phone: 276-620-7433
  • 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: LEON ALLEY
Title or Position: OWNER
Credential:
Phone: 276-620-7433