Provider Demographics
NPI:1407566425
Name:PRIORITY MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:PRIORITY MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFONZO
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENEZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-478-8425
Mailing Address - Street 1:709 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3607
Mailing Address - Country:US
Mailing Address - Phone:224-478-8425
Mailing Address - Fax:
Practice Address - Street 1:709 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3607
Practice Address - Country:US
Practice Address - Phone:224-478-8425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)