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General NPI Number Information
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NPI Number | 1497933477
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Entity Type | Organization
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Legal Business Name | EAGLE MEDICAL TRANSPORTS, LLC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 570 INDUSTRIAL PARK DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-8636
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Country | US
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Telephone | 804-824-8019
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Fax |
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Provider Business Mailing Address
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Address Line | 570 INDUSTRIAL PARK DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-8636
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Country | US
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Telephone | 804-824-8019
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Fax |
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Authorized Official
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Title or Position | MEMBER, MANAGER
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Name | MR. SHAUN ALLEN SORENSEN
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Credential | EMT-I
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Telephone | 804-824-8019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1277
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License Number State | VA
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