Provider Demographics
NPI:1407047426
Name:RELIANT MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:RELIANT MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT-P
Authorized Official - Phone:843-577-8032
Mailing Address - Street 1:786 JOHNNIE DODDS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3047
Mailing Address - Country:US
Mailing Address - Phone:843-577-8032
Mailing Address - Fax:866-457-2546
Practice Address - Street 1:786 JOHNNIE DODDS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3047
Practice Address - Country:US
Practice Address - Phone:843-577-8032
Practice Address - Fax:866-457-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0265Medicaid