MEDICARE: RVA MEDICAL 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1083259048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RVA MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2524 GRAND GLEN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2167
Country	:	US
Telephone Number	:	804-687-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 GRAND GLEN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2167
Country	:	US
Telephone Number	:	804-687-1331
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL JOEL ERVIN
Credential	:
Telephone Number	:	804-687-1331

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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