Provider Demographics
NPI:1295376838
Name:LUKE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:LUKE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:RAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-265-5361
Mailing Address - Street 1:750 MIMMS CT NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6227
Mailing Address - Country:US
Mailing Address - Phone:765-265-5361
Mailing Address - Fax:678-567-7922
Practice Address - Street 1:260 INTERNATIONAL PKWY STE 132
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-5706
Practice Address - Country:US
Practice Address - Phone:765-265-5361
Practice Address - Fax:678-567-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance