=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063932507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AERO SHUTTLE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2017
-----------------------------------------------------
Last Update Date | 06/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 HITCHENS LN
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-223-5151
-----------------------------------------------------
Fax | 757-592-9090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 NICOLE PL
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-223-5151
-----------------------------------------------------
Fax | 757-592-9090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LEONARDO DURANT WATFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-377-6178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------