MEDICARE: JASON O'NEAL GRAVELY

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	:	1851953137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON O'NEAL GRAVELY

Provider Business Mailing Address
First Line	:	344 TURNER ASHBY RD
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-0638
Country	:	US
Telephone Number	:	276-732-6030
Fax Number	:	276-336-3029

Provider Business Practice Location Address
First Line	:	344 TURNER ASHBY RD
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-0638
Country	:	US
Telephone Number	:	276-732-6030
Fax Number	:	276-336-3029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/30/2019

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