MEDICARE: RELIANCE 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)	B201201852	VA
2	3416L0300X	Land Ambulance	B201201852	VA

General Provider Information

NPI Number	:	1609203140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANCE MEDICAL TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	156 NEWTOWN RD STE A-1
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2410
Country	:	US
Telephone Number	:	757-456-5147
Fax Number	:	757-456-5149

Provider Business Practice Location Address
First Line	:	5261 CHALLEDON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6315
Country	:	US
Telephone Number	:	757-456-5147
Fax Number	:	757-456-5149

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL PROJECTS
Name	:	JASON GRIMES
Credential	:
Telephone Number	:	757-456-5147

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	08/30/2023

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