=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285010819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A-1 METRO TRANSPORTATION SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2015
-----------------------------------------------------
Last Update Date | 08/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8257 HULL STREET RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-6413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-399-9042
-----------------------------------------------------
Fax | 877-244-4588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8255 HULL STREET RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-6413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-399-1205
-----------------------------------------------------
Fax | 877-244-4588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VCE PRESIDENT
-----------------------------------------------------
Name | MS. TAHA LATIMORE SHARON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-399-1205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------