Provider Demographics
NPI:1942778519
Name:ANGEL WINGS MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ANGEL WINGS MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-748-1133
Mailing Address - Street 1:5879 CLEAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4601
Mailing Address - Country:US
Mailing Address - Phone:757-748-1133
Mailing Address - Fax:
Practice Address - Street 1:5879 CLEAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4601
Practice Address - Country:US
Practice Address - Phone:757-748-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)