Provider Demographics
NPI:1467918961
Name:CHAMPION TRANSPORTATION LLC
Entity Type:Organization
Organization Name:CHAMPION TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-887-3443
Mailing Address - Street 1:938 KENNERLY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4612
Mailing Address - Country:US
Mailing Address - Phone:804-887-3443
Mailing Address - Fax:804-320-2090
Practice Address - Street 1:938 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4612
Practice Address - Country:US
Practice Address - Phone:804-887-3443
Practice Address - Fax:804-320-2090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)