Provider Demographics
NPI:1245400357
Name:SOUTHEASTERN MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-460-7107
Mailing Address - Street 1:120 GOURDIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-3377
Mailing Address - Country:US
Mailing Address - Phone:803-460-7107
Mailing Address - Fax:
Practice Address - Street 1:120 GOURDIN ST
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-3377
Practice Address - Country:US
Practice Address - Phone:803-460-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)