Provider Demographics
NPI:1962134486
Name:EXQUISITE MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:EXQUISITE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-270-5907
Mailing Address - Street 1:15530 COSBY VILLAGE AVE APT 422
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2142
Mailing Address - Country:US
Mailing Address - Phone:646-270-5907
Mailing Address - Fax:
Practice Address - Street 1:15530 COSBY VILLAGE AVE APT 422
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2142
Practice Address - Country:US
Practice Address - Phone:646-270-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)