=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295221554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA & OMEGA TRANSPORTATIONS SERVICES L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2018
-----------------------------------------------------
Last Update Date | 07/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2314 FAIRFIELD AVE
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23223-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-918-5474
-----------------------------------------------------
Fax | 804-716-7261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2314 FAIRFIELD AVE
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23223-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-918-5474
-----------------------------------------------------
Fax | 804-716-7261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. KRISTINA LYNN IGWEIKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-252-4307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 40273
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------