MEDICARE: FIRSTCLASSRIDES 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	:	1245969815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRSTCLASSRIDES LLC

Provider Business Mailing Address
First Line	:	160 OLD TAVERN CIR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-7748
Country	:	US
Telephone Number	:	434-822-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 TARDY MOUNTAIN RD
Second Line	:
City	:	ALTAVISTA
State	:	VA
Zip	:	24517-3015
Country	:	US
Telephone Number	:	434-700-5698
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTONIO OBRIAN GRAVES
Credential	:
Telephone Number	:	434-822-3230

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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