=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750199907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSSI LOGISTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 01/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 ARMY NAVY DR APT 202
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-647-9654
-----------------------------------------------------
Fax | 703-647-9797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 ARMY NAVY DR APT 202
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-647-9654
-----------------------------------------------------
Fax | 703-647-9797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MIRIAN POPKHADZE
-----------------------------------------------------
Credential | MR.
-----------------------------------------------------
Telephone | 703-647-9654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------