Individual
IRA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 FAMILY WAY LANE, HEATHSVILLE, VA 22473
(804) 580-8117
Mailing address
28 FAMILY WAY LANE, HEATHSVILLE, VA 22473
(804) 580-8117
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
T66908696
VA
Other
Enumeration date
03/31/2018
Last updated
03/31/2018
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