Provider Demographics
NPI:1316396955
Name:FAITHFUL MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:FAITHFUL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAKEDRIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-449-5037
Mailing Address - Street 1:216 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1408
Mailing Address - Country:US
Mailing Address - Phone:757-449-5037
Mailing Address - Fax:
Practice Address - Street 1:216 W 33RD ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1408
Practice Address - Country:US
Practice Address - Phone:757-449-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60621809343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)