Carl Perez
Individual provider Active NPI Driver · Heathsville, VA
NPI 1740041334 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1740041334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- T66814545 (VA)
- Practice address
- 766 Miskimon Rd
Heathsville, VA 22473-3820 - Phone
- (434) 942-7172
- NPI assigned
- Jan 19, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T66814545 | VA | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breakingforth Transportation LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | T66814545 | VA | Yes |
Addresses
Primary practice location
766 Miskimon Rd
Heathsville, VA 22473-3820
Mailing address
766 Miskimon Rd
Heathsville, VA 22473-3820
Phone (434) 942-7172
Other providers in Heathsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.