Provider Demographics
NPI:1457041709
Name:PEGASUS MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:PEGASUS MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:SHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-656-6942
Mailing Address - Street 1:7233 TOWLES MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551
Mailing Address - Country:US
Mailing Address - Phone:540-656-6942
Mailing Address - Fax:
Practice Address - Street 1:7233 TOWLES MILL ROAD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551
Practice Address - Country:US
Practice Address - Phone:540-656-6942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEGASUS MEDICAL TRANSPORT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)