Provider Demographics
NPI:1669857835
Name:D19 TRANSPORTATION SERVICE INC.
Entity Type:Organization
Organization Name:D19 TRANSPORTATION SERVICE INC.
Other - Org Name:D19 CAB SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:434-632-1157
Mailing Address - Street 1:112 LAVENDER DRIVE
Mailing Address - Street 2:A
Mailing Address - City:MAX MEADOWS
Mailing Address - State:VA
Mailing Address - Zip Code:24360
Mailing Address - Country:US
Mailing Address - Phone:434-623-1157
Mailing Address - Fax:866-230-2666
Practice Address - Street 1:10004 BLUE STAR HWY
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-3218
Practice Address - Country:US
Practice Address - Phone:434-632-1157
Practice Address - Fax:866-230-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24510343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA66178OtherVIRGINIA PREMIER HEALTH PLAN