Provider Demographics
NPI:1114124450
Name:TRI COUNTY MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:TRI COUNTY MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-974-7600
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-0708
Mailing Address - Country:US
Mailing Address - Phone:252-974-7600
Mailing Address - Fax:252-974-7600
Practice Address - Street 1:551 HILL ROAD
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-0708
Practice Address - Country:US
Practice Address - Phone:252-974-7600
Practice Address - Fax:252-974-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1614343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406856Medicaid
NC2783146Medicare ID - Type Unspecified