Provider Demographics
NPI:1144225533
Name:MEDICAL TRANSPORTATION SERVICES, LLC
Entity Type:Organization
Organization Name:MEDICAL TRANSPORTATION SERVICES, LLC
Other - Org Name:PHYSICIANS TRANSPORT SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRETON
Authorized Official - Suffix:
Authorized Official - Credentials:MEDIC
Authorized Official - Phone:571-323-0800
Mailing Address - Street 1:360 HERNDON PKWY
Mailing Address - Street 2:STE 1200
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4824
Mailing Address - Country:US
Mailing Address - Phone:571-323-0800
Mailing Address - Fax:571-323-0801
Practice Address - Street 1:360 HERNDON PKWY
Practice Address - Street 2:STE 1200
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4824
Practice Address - Country:US
Practice Address - Phone:571-323-0800
Practice Address - Fax:571-323-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05404023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009012397Medicaid
VA490076Medicare UPIN