Provider Demographics
NPI:1255319919
Name:MEDTRAN
Entity type:Organization
Organization Name:MEDTRAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-572-3886
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:VA
Mailing Address - Zip Code:24520-0014
Mailing Address - Country:US
Mailing Address - Phone:434-572-3886
Mailing Address - Fax:434-572-3606
Practice Address - Street 1:509 CHALMERS ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2401
Practice Address - Country:US
Practice Address - Phone:434-572-3886
Practice Address - Fax:434-572-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA176878OtherANTHEM MEDIGAP NUMBER
VAP00433010OtherRAILROAD MEDICARE