Provider Demographics
NPI:1245399492
Name:FAMILY MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL TRANSPORT, LLC
Other - Org Name:FAMILY MEDICAL SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FANALE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-INTERMEDIATE
Authorized Official - Phone:770-503-4411
Mailing Address - Street 1:4562 WINDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8111
Mailing Address - Country:US
Mailing Address - Phone:770-503-4411
Mailing Address - Fax:678-267-3137
Practice Address - Street 1:4562 WINDSTONE CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-8111
Practice Address - Country:US
Practice Address - Phone:770-503-4411
Practice Address - Fax:678-267-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25422343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)