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General NPI Number Information
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NPI Number | 1093260846
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Entity Type | Organization
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Legal Business Name | MIRACLE MEDICAL TRANSPORT
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 2597 QUALITY CT UNIT 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5299
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Country | US
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Telephone | 757-273-7360
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 THALIA STATION CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1755
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Country | US
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Telephone | 443-968-1273
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. WENDI KEMP
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Credential |
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Telephone | 757-273-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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