Provider Demographics
NPI:1356639801
Name:FRIENDLY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:FRIENDLY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-808-3400
Mailing Address - Street 1:3402 MANDY LANE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3276
Mailing Address - Country:US
Mailing Address - Phone:252-808-3400
Mailing Address - Fax:252-808-3403
Practice Address - Street 1:3402 MANDY LANE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3276
Practice Address - Country:US
Practice Address - Phone:252-808-3400
Practice Address - Fax:252-808-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3428682Medicaid
NC6601867Medicaid