1669719266 NPI number — HEART OF GEORGIA MEDICAL TRANSPORT LLC

Table of content: (NPI 1669719266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669719266 NPI number — HEART OF GEORGIA MEDICAL TRANSPORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF GEORGIA 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:
1669719266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31208-5623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-960-1067
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2014 RIVERSIDE DR.
Provider Second Line Business Practice Location Address:
SUITE 2F
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31204-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-960-1067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTERED AGENT
Authorized Official Telephone Number:
478-335-1817

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  011-05 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com