Provider Demographics
NPI:1710934617
Name:CARILION CLINIC PATIENT TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:CARILION CLINIC PATIENT TRANSPORTATION, LLC
Other - Org Name:CARILION PATIENT TRANSPORTATION SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EVP. TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5125
Mailing Address - Street 1:P.O. BOX 11865
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24022
Mailing Address - Country:US
Mailing Address - Phone:540-981-8731
Mailing Address - Fax:540-344-5674
Practice Address - Street 1:431 MCCLANAHAN ST. SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1756
Practice Address - Country:US
Practice Address - Phone:540-981-8731
Practice Address - Fax:540-344-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X, 3416L0300X
VA4683416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145210000Medicaid
VA282817OtherANTHEM BCBS
WV0146080000Medicaid
VA009010131Medicaid
VA009020306Medicaid
VA009012401Medicaid
VA282625OtherANTHEM BCBS
VA282625OtherANTHEM BCBS
VA590011752Medicare PIN