=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295535839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYFAVORITETRANSPORTATIONNEMTLLC.COM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 HIGH ST STE 5
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23707-3321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-418-3457
-----------------------------------------------------
Fax | 757-337-4274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 HIGH ST STE 5
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23707-3321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-418-3457
-----------------------------------------------------
Fax | 757-337-4274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DARRYLE JEREMIAH ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-418-3457
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------