Provider Demographics
NPI:1376962928
Name:PREMIAER CARE MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:PREMIAER CARE MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-254-3107
Mailing Address - Street 1:17 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4410
Mailing Address - Country:US
Mailing Address - Phone:856-875-2273
Mailing Address - Fax:856-875-2275
Practice Address - Street 1:17 MADISON LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4410
Practice Address - Country:US
Practice Address - Phone:856-875-2273
Practice Address - Fax:856-875-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1006943416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)