Provider Demographics
NPI:1275894362
Name:ADVANCE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-903-4268
Mailing Address - Street 1:PO BOX 8069
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-8069
Mailing Address - Country:US
Mailing Address - Phone:843-903-4268
Mailing Address - Fax:843-651-3352
Practice Address - Street 1:875 NICHOLAS ST
Practice Address - Street 2:UNITA
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-4312
Practice Address - Country:US
Practice Address - Phone:843-903-4268
Practice Address - Fax:843-651-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport