Provider Demographics
NPI:1316334170
Name:DELTA MEDICAL TRANSPORT
Entity type:Organization
Organization Name:DELTA MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-755-7774
Mailing Address - Street 1:4795 BETHLEHEM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2516
Mailing Address - Country:US
Mailing Address - Phone:804-755-7774
Mailing Address - Fax:804-755-1709
Practice Address - Street 1:4795 BETHLEHEM RD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2516
Practice Address - Country:US
Practice Address - Phone:804-755-7774
Practice Address - Fax:804-755-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA139341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528400702OtherNPI
VAQ454020001OtherPROVIDER TRANSACTION ACCESS NUMBER