MEDICARE: STELLAR SERVICES OF VIRGINIA 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	:	1336826957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLAR SERVICES OF VIRGINIA LLC

Provider Business Mailing Address
First Line	:	1725 SPRINGFIELD AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-2337
Country	:	US
Telephone Number	:	757-835-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 SPRINGFIELD AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-2337
Country	:	US
Telephone Number	:	757-835-8440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NIKKIRA BYNUM
Credential	:
Telephone Number	:	757-449-0229

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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