Healthcare Provider Details

I. General information

NPI: 1316716632
Provider Name (Legal Business Name): SIMPLY AMAZING TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 ALISHIRE CT
VA BEACH VA
23464-5439
US

IV. Provider business mailing address

5313 ALISHIRE CT
VA BEACH VA
23464-5439
US

V. Phone/Fax

Practice location:
  • Phone: 678-538-7455
  • Fax:
Mailing address:
  • Phone: 678-538-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: LATRICE SIMPKINS-BELLAMY
Title or Position: OWNER
Credential:
Phone: 678-538-7455