MEDICARE: R.A TRANSPORTATION 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	:	1649965302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.A TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6522 PRIMROSE PL
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6522 PRIMROSE PL
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4214
Country	:	US
Telephone Number	:	703-626-0795
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AKALEWOLD MENGISTAE
Credential	:
Telephone Number	:	703-626-0795

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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