Provider Demographics
NPI:1497933477
Name:EAGLE MEDICAL TRANSPORTS, LLC
Entity Type:Organization
Organization Name:EAGLE MEDICAL TRANSPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:804-824-8019
Mailing Address - Street 1:570 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-8636
Mailing Address - Country:US
Mailing Address - Phone:804-824-8019
Mailing Address - Fax:
Practice Address - Street 1:570 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-8636
Practice Address - Country:US
Practice Address - Phone:804-824-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA628SMedicare PIN