1750317483 NPI number — PRIORITY CARE MEDICAL TRANSPORT, LLC

Table of content: MRS. SARAH ANNE BENNICK MSN, APRN, CPNP (NPI 1457699118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750317483 NPI number — PRIORITY CARE MEDICAL TRANSPORT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY CARE MEDICAL TRANSPORT, LLC
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:
1750317483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 S ROCHESTER STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-8179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-600-2501
Provider Business Mailing Address Fax Number:
800-600-2502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 EAST RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIDOR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77662-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-600-3320
Provider Business Practice Location Address Fax Number:
800-600-2502
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KARRAS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT & SECRETAR
Authorized Official Telephone Number:
800-600-2501

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  800156 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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