Provider Demographics
NPI:1982348959
Name:EXTENDED FAMILY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:EXTENDED FAMILY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-714-2255
Mailing Address - Street 1:1105 HUGO ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3357
Mailing Address - Country:US
Mailing Address - Phone:757-714-2255
Mailing Address - Fax:
Practice Address - Street 1:1117 VALLEY DR UNIT 3463
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2414
Practice Address - Country:US
Practice Address - Phone:757-813-3814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)