Provider Demographics
NPI:1225305964
Name:AMTRAN MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:AMTRAN MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-291-0043
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0676
Mailing Address - Country:US
Mailing Address - Phone:706-291-0043
Mailing Address - Fax:
Practice Address - Street 1:1611 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1621
Practice Address - Country:US
Practice Address - Phone:706-291-0043
Practice Address - Fax:706-622-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129208AMedicaid
GA202G598393Medicare PIN