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General NPI Number Information
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NPI Number | 1184591257
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Entity Type | Organization
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Legal Business Name | PROVISIONS MEDICAL TRANSPORT, LLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 947 MILDRED ST UNIT B
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City | NORFOLK
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State | VA
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Zip | 23518-2529
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Country | US
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Telephone | 757-609-8098
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8126
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City | NORFOLK
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State | VA
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Zip | 23503-0126
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Country | US
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Telephone | 757-609-8098
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DOMINIQUE HODGES
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Credential |
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Telephone | 757-609-8098
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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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