1871589937 NPI number — MID-MARYLAND MEDICAL TRANSPORT LLC

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 1871589937 NPI number — MID-MARYLAND MEDICAL TRANSPORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-MARYLAND 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:
1871589937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-553-4220
Provider Business Mailing Address Fax Number:
540-536-4359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 ELDRIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-733-6655
Provider Business Practice Location Address Fax Number:
301-733-4229
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEISEY
Authorized Official First Name:
M
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
540-536-5260

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015107600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385544 . This is a "TRIGO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7667189 . This is a "AETNA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590014790 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90142127 . This is a "VA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2473443 . This is a "AETNA BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: TR68MI . This is a "BS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800301700 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2110905 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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