Provider Demographics
NPI:1285192781
Name:PROMED TRANSPORT LLC
Entity Type:Organization
Organization Name:PROMED TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-667-0436
Mailing Address - Street 1:182 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-2131
Mailing Address - Country:US
Mailing Address - Phone:727-667-0436
Mailing Address - Fax:770-814-0212
Practice Address - Street 1:1720 LEXINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2330
Practice Address - Country:US
Practice Address - Phone:770-800-8007
Practice Address - Fax:770-800-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1497298905OtherBILLING