Provider Demographics
NPI:1306208749
Name:MIRACLE TRANSPORT SERVICES, LLC
Entity Type:Organization
Organization Name:MIRACLE TRANSPORT SERVICES, LLC
Other - Org Name:MIRACLE TRANSPORT SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-201-8145
Mailing Address - Street 1:654 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6733
Mailing Address - Country:US
Mailing Address - Phone:717-201-8145
Mailing Address - Fax:
Practice Address - Street 1:654 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6733
Practice Address - Country:US
Practice Address - Phone:717-201-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA-6416846343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)