Provider Demographics
NPI:1598989659
Name:MTI OF VIRGINIA INC.
Entity Type:Organization
Organization Name:MTI OF VIRGINIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-245-0797
Mailing Address - Street 1:1001 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-6438
Mailing Address - Country:US
Mailing Address - Phone:757-245-0797
Mailing Address - Fax:757-245-0798
Practice Address - Street 1:1001 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-6438
Practice Address - Country:US
Practice Address - Phone:757-245-0797
Practice Address - Fax:757-245-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17893343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0601007OtherCAGE NUMBER 3W5D3