=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104652411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE RIDGE TRANSPORTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 SIGNAL KNOB COTTAGE DR
-----------------------------------------------------
City | STRASBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22657-3799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-671-3884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 SIGNAL KNOB COTTAGE DR
-----------------------------------------------------
City | STRASBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22657-3799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACTING AGENT/OWNER
-----------------------------------------------------
Name | LUIS C PATRICIO JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-671-3884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------