MEDICARE: STEADFAST 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	:	1427793405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEADFAST MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	266 WELLER BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7265
Country	:	US
Telephone Number	:	757-639-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 WELLER BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7265
Country	:	US
Telephone Number	:	757-639-0904
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. STEPHANIE MICHELLE ROLLINS
Credential	:
Telephone Number	:	757-639-0904

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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