Provider Demographics
NPI:1225686512
Name:BLUE ORCHID MEDICAL TRANSIT LLC
Entity Type:Organization
Organization Name:BLUE ORCHID MEDICAL TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ATTLEE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-334-2997
Mailing Address - Street 1:PO BOX 14371
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4371
Mailing Address - Country:US
Mailing Address - Phone:984-269-7045
Mailing Address - Fax:
Practice Address - Street 1:3405 MOGOLLON CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6467
Practice Address - Country:US
Practice Address - Phone:984-269-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport