MEDICARE: GASBURG EXPRESS 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	:	1821648452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASBURG EXPRESS TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2100 OAK GROVE RD
Second Line	:
City	:	GASBURG
State	:	VA
Zip	:	23857-2328
Country	:	US
Telephone Number	:	434-774-4534
Fax Number	:	434-577-9344

Provider Business Practice Location Address
First Line	:	2100 OAK GROVE RD
Second Line	:
City	:	GASBURG
State	:	VA
Zip	:	23857-2328
Country	:	US
Telephone Number	:	434-774-4534
Fax Number	:	434-577-9344

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAMOND BROWN III
Credential	:
Telephone Number	:	434-774-4534

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2019

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