1578916003 NPI number — EXECUTIVE MEDICAL TRANSPORTATION, LTD

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 1578916003 NPI number — EXECUTIVE MEDICAL TRANSPORTATION, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVE MEDICAL TRANSPORTATION, LTD
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:
EXECUTIVE MEDICAL TRANSPORTATION, INC
Provider Other Organization Name Type Code:
3
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:
1578916003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6938 FAUST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-7529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-501-5189
Provider Business Mailing Address Fax Number:
803-569-6735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 MILL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLLOCKSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28573-9312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-501-5189
Provider Business Practice Location Address Fax Number:
803-569-6735
Provider Enumeration Date:
07/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
LUCRETIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MEDICAL TRANSPORT DIRECTOR/OWNER
Authorized Official Telephone Number:
240-501-5189

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343800000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 344600000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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