1710934617 NPI number — CARILION CLINIC PATIENT TRANSPORTATION, LLC

Table of content: (NPI 1710934617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710934617 NPI number — CARILION CLINIC PATIENT TRANSPORTATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARILION CLINIC PATIENT TRANSPORTATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARILION PATIENT TRANSPORTATION SERVICES, LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710934617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11865
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-981-8731
Provider Business Mailing Address Fax Number:
540-344-5674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 MCCLANAHAN ST. SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24014-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-981-8731
Provider Business Practice Location Address Fax Number:
540-344-5674
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LORTON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EVP. TREASURER
Authorized Official Telephone Number:
540-224-5125

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 468 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 468 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0145210000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282817 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0146080000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009010131 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009020306 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009012401 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282625 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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