MEDICARE: CHARITY TRANSPORT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi	20276	VA
2	251E00000X	Home Health Agency	HCO-171533	VA
3	343800000X	Secured Medical Transport (VAN)	202	VA
4	347C00000X	Private Vehicle	202	VA
5	343800000X	Secured Medical Transport (VAN)	905705	VA
6	347C00000X	Private Vehicle	905705	VA
7	343900000X	Non-emergency Medical Transport (VAN)	202	VA
8	343900000X	Non-emergency Medical Transport (VAN)	905705	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0153841405	OTHER	VA	API

General Provider Information

NPI Number	:	1033427448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARITY TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	1225 RIVER OAKS DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2041
Country	:	US
Telephone Number	:	757-226-9916
Fax Number	:	757-512-8802

Provider Business Practice Location Address
First Line	:	1637 INDEPENDENCE BLVD
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4038
Country	:	US
Telephone Number	:	757-226-9916
Fax Number	:	757-512-8802

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MS. TRACY LORRAINE JONES
Credential	:
Telephone Number	:	757-309-3975

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	12/07/2016

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Directions to “CHARITY TRANSPORT, LLC ” Practice Location

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