Healthcare Provider Details

I. General information

NPI: 1932569217
Provider Name (Legal Business Name): MIV TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NEWBRIDGE TER
RICHMOND VA
23223-9114
US

IV. Provider business mailing address

430 NEWBRIDGE TER
RICHMOND VA
23223-9114
US

V. Phone/Fax

Practice location:
  • Phone: 804-761-7922
  • Fax:
Mailing address:
  • Phone: 804-761-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAVINA ROCHELLE JOHNSON
Title or Position: OWNER/ MANAGER
Credential:
Phone: 804-761-7922