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General NPI Number Information
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NPI Number | 1811555097
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Entity Type | Organization
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Legal Business Name | PHOENIX CHARLES TRANSPORTATION, LLC
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 544 HICKS DR
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City | BRACEY
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State | VA
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Zip | 23919-1623
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Country | US
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Telephone | 757-870-9025
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Fax | 804-352-5649
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Provider Business Mailing Address
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Address Line | 544 HICKS DR
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City | BRACEY
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State | VA
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Zip | 23919-1623
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Country | US
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Telephone | 757-870-9025
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Fax | 804-352-5649
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | JUDY ANN MARCHAND HAMPTON
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Credential | DO
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Telephone | 804-536-3229
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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 |
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License Number State |
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