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General NPI Number Information
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NPI Number | 1174169619
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Entity Type | Organization
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Legal Business Name | VANTAGE MEDICAL TRANS
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 13652 JAMES MADISON HWY UNIT G
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City | PALMYRA
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State | VA
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Zip | 22963-4499
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Country | US
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Telephone | 434-305-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 MAYMONT CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-6497
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Country | US
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Telephone | 434-305-7728
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HABIB RAHIM SR.
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Credential |
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Telephone | 434-305-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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