MEDICARE: RED WHITE AND BLUE LOGISTICS SOLUTION 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)	481	VA

General Provider Information

NPI Number	:	1851846570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED WHITE AND BLUE LOGISTICS SOLUTION LLC

Provider Business Mailing Address
First Line	:	11004 WHITEPINE DR
Second Line	:
City	:	NORTH PRINCE GEORGE
State	:	VA
Zip	:	23860-7648
Country	:	US
Telephone Number	:	804-586-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11004 WHITEPINE DR
Second Line	:
City	:	NORTH PRINCE GEORGE
State	:	VA
Zip	:	23860-7648
Country	:	US
Telephone Number	:	804-586-5500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLORIA EVANS
Credential	:
Telephone Number	:	804-586-5500

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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