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General NPI Number Information
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NPI Number | 1063984292
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Entity Type | Organization
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Legal Business Name | ISC MEDICAL TRANSPORT LLC
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 764 MCGUIRE PL
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1630
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Country | US
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Telephone | 757-638-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 SPRINGWELL PL
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-7717
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Country | US
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Telephone | 757-715-3496
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY LEON CHASE
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Credential |
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Telephone | 757-638-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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