Provider Demographics
NPI:1063673655
Name:WILSON MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:WILSON MEDICAL TRANSPORT
Other - Org Name:WILSON MEDICAL TRANSPORT SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTP
Authorized Official - Phone:843-325-5590
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:SC
Mailing Address - Zip Code:29591-0414
Mailing Address - Country:US
Mailing Address - Phone:877-760-4968
Mailing Address - Fax:843-407-7297
Practice Address - Street 1:1943 BOYD RD
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:SC
Practice Address - Zip Code:29591
Practice Address - Country:US
Practice Address - Phone:877-760-4968
Practice Address - Fax:843-407-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC056341600000X, 3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)