Healthcare Provider Details

I. General information

NPI: 1528495116
Provider Name (Legal Business Name): D19 TRANSPORTATION SERVICE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 BLUE STAR HWY
STONY CREEK VA
23882-3218
US

IV. Provider business mailing address

10004 BLUE STAR HWY
STONY CREEK VA
23882-3218
US

V. Phone/Fax

Practice location:
  • Phone: 434-632-1157
  • Fax: 866-230-2666
Mailing address:
  • Phone: 434-632-1157
  • Fax: 866-230-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number24510
License Number StateVA

VIII. Authorized Official

Name: EARL A BLACKMAN
Title or Position: PRESIDENT
Credential: ATP
Phone: 434-632-1157