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General NPI Number Information
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NPI Number | 1598989659
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Entity Type | Organization
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Legal Business Name | MTI OF VIRGINIA INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1001 WICKHAM AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-6438
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Country | US
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Telephone | 757-245-0797
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Fax | 757-245-0798
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Provider Business Mailing Address
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Address Line | 1001 WICKHAM AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-6438
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Country | US
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Telephone | 757-245-0797
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Fax | 757-245-0798
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CLEVELAND C. MABRY
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Credential |
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Telephone | 757-245-0797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 17893
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License Number State | VA
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