Provider Demographics
NPI:1558076059
Name:BLOSSOM MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:BLOSSOM MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER-HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-789-0609
Mailing Address - Street 1:8009 WHITEHALL EXECUTIVE CENTER DR APT 4105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8009 WHITEHALL EXECUTIVE CENTER DR APT 4105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7892
Practice Address - Country:US
Practice Address - Phone:585-789-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40400181Medicaid