Provider Demographics
NPI:1114504800
Name:COMMUNITY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:FENDER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:706-621-8861
Mailing Address - Street 1:1110 OWENS CIR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2546
Mailing Address - Country:US
Mailing Address - Phone:706-621-8861
Mailing Address - Fax:
Practice Address - Street 1:1110 OWENS CIR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2546
Practice Address - Country:US
Practice Address - Phone:706-621-8861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)