=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376043612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASAP TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2018
-----------------------------------------------------
Last Update Date | 11/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23621 WILLSHAW SQ APT 202
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20148-7701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-554-5444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9111 ANTIQUE WAY
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20110-5362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-554-5444
-----------------------------------------------------
Fax | 571-428-2259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAVEH RAZI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-875-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------