Healthcare Provider Details

I. General information

NPI: 1154555779
Provider Name (Legal Business Name): LADYBUG TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MILL RACE RD
RICHMOND VA
23234-3841
US

IV. Provider business mailing address

3305 MILL RACE RD
RICHMOND VA
23234-3841
US

V. Phone/Fax

Practice location:
  • Phone: 804-382-0981
  • Fax:
Mailing address:
  • Phone: 804-382-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberT69878320
License Number StateVA

VIII. Authorized Official

Name: DARYL A HARRISON
Title or Position: ASSOCIATE BROKER
Credential:
Phone: 804-382-0981