=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215731229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALMED CARE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2025
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3551 MIKE PADGETT HWY APT 2G
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-675-7583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 ROBERT C DANIEL JR PKWY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-675-7583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEGAL REPRESENTATIVE
-----------------------------------------------------
Name | VANESSA ANN FOSTER
-----------------------------------------------------
Credential | N/A
-----------------------------------------------------
Telephone | 706-513-2734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------