Provider Demographics
NPI:1104391747
Name:SAMPSON TRANSPORTATION AND DISTRIBUTION
Entity Type:Organization
Organization Name:SAMPSON TRANSPORTATION AND DISTRIBUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-710-1584
Mailing Address - Street 1:313 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5246
Mailing Address - Country:US
Mailing Address - Phone:434-710-1584
Mailing Address - Fax:
Practice Address - Street 1:313 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5246
Practice Address - Country:US
Practice Address - Phone:434-710-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid