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General NPI Number Information
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NPI Number | 1689060899
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Entity Type | Organization
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Legal Business Name | INDEPENDENT CAPACITY TRANSPORTATION SERVICES, INC.
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 16017 CONTINENTAL BLVD
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-5900
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Country | US
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Telephone | 804-520-7773
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Fax | 804-214-2177
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Provider Business Mailing Address
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Address Line | PO BOX 3163
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City | PETERSBURG
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State | VA
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Zip | 23805-3163
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Country | US
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Telephone | 804-520-7773
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Fax | 804-214-2177
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PASCAL THEBAUD
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Credential |
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Telephone | 804-520-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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