=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366011595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEST SHUTTLE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2021
-----------------------------------------------------
Last Update Date | 07/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 RUCKER DR
-----------------------------------------------------
City | RUCKERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22968-9527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-353-2875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2405 PIMPERNEL DR
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20603-4944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-353-2875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | COREY E CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-353-2875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------