1427051382 NPI number — MAR MAC TRANSPORTATION SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427051382 NPI number — MAR MAC TRANSPORTATION SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAR MAC TRANSPORTATION SERVICES 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:
Provider Other Organization Name Type Code:
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:
1427051382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 538341
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30353-8341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-343-7153
Provider Business Mailing Address Fax Number:
757-787-9436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 INCUBATOR RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23661-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-343-7153
Provider Business Practice Location Address Fax Number:
757-787-9436
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
T
Authorized Official Title or Position:
AR MGR
Authorized Official Telephone Number:
757-655-0029

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  882 , 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: 317940 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 590013449 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009012648 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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