Healthcare Provider Details

I. General information

NPI: 1609707298
Provider Name (Legal Business Name): MICKLES MOBILITY TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 BROWNS MILL RD
RUSTBURG VA
24588-2598
US

IV. Provider business mailing address

PO BOX 22
RUSTBURG VA
24588-0022
US

V. Phone/Fax

Practice location:
  • Phone: 434-941-3934
  • Fax:
Mailing address:
  • Phone: 434-941-3934
  • 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: MARCIA MICKLES
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 434-941-3934