Provider Demographics
NPI:1437215647
Name:SUPPORT MEDICAL TRANSPORT SERVICE
Entity Type:Organization
Organization Name:SUPPORT MEDICAL TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-989-9135
Mailing Address - Street 1:7550 BERTRAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-3134
Mailing Address - Country:US
Mailing Address - Phone:219-989-9135
Mailing Address - Fax:219-845-5594
Practice Address - Street 1:7550 BERTRAM AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-3134
Practice Address - Country:US
Practice Address - Phone:219-989-9135
Practice Address - Fax:219-845-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN62072343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)