=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497460224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 T'S TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2023
-----------------------------------------------------
Last Update Date | 01/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1726 NORWOOD AVE
-----------------------------------------------------
City | SOUTH BOSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24592-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-272-0911
-----------------------------------------------------
Fax | 434-575-1231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1726 NORWOOD AVE
-----------------------------------------------------
City | SOUTH BOSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24592-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-272-0911
-----------------------------------------------------
Fax | 434-575-1231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CORNELIUS RAY BRANDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-272-0911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------