Organization
ADVANCED LIFE SUPPORT CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAWIA BAKRI MOHAMED (OWNER)
(540) 207-9284
Entity
Organization
Contact information
Practice address
11905 MAIN ST, FREDERICKSBURG, VA 22408-7326
(540) 207-9284
(540) 898-8138
Mailing address
PO BOX 6101, FREDERICKSBURG, VA 22403-6101
(540) 207-9287
(540) 898-8138
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
166
VA
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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