Healthcare Provider Details

I. General information

NPI: 1811326796
Provider Name (Legal Business Name): BLUE CAB OF MARTINSBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W. RACE STREEET UNIT #1
MARTINSBURG WV
25401
US

IV. Provider business mailing address

142 BAKER ST
WINCHESTER VA
22601-5035
US

V. Phone/Fax

Practice location:
  • Phone: 540-323-0123
  • Fax:
Mailing address:
  • Phone: 540-323-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number7544
License Number StateWV

VIII. Authorized Official

Name: MR. FREDERICK KIRBY GARRETT
Title or Position: OWNER
Credential:
Phone: 540-323-0123