1659529626 NPI number — SOUTHERN MEDICAL TRANSPORT SERVICE INC

Table of content: (NPI 1659529626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659529626 NPI number — SOUTHERN MEDICAL TRANSPORT SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MEDICAL TRANSPORT SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN MEDICAL TRANSPORTATION SERVICES INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659529626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3813 POINT ELIZABETH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23321-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-338-1681
Provider Business Mailing Address Fax Number:
757-295-9765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3813 POINT ELIZABETH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23321-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-338-1681
Provider Business Practice Location Address Fax Number:
757-295-9765
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEKRANS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT/CHIEF
Authorized Official Telephone Number:
17573381681

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1199 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1199 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659529626 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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