Provider Demographics
NPI:1144793381
Name:SQUARE ONE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SQUARE ONE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-699-8045
Mailing Address - Street 1:2090 RED HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-4741
Mailing Address - Country:US
Mailing Address - Phone:706-699-8045
Mailing Address - Fax:
Practice Address - Street 1:2090 RED HAVEN DR
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-4741
Practice Address - Country:US
Practice Address - Phone:706-699-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)