Provider Demographics
NPI:1447239223
Name:MEMORIAL HEALTH TRANSPORTONE INC
Entity Type:Organization
Organization Name:MEMORIAL HEALTH TRANSPORTONE INC
Other - Org Name:MEDSTARONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-350-8386
Mailing Address - Street 1:PO BOX 16268
Mailing Address - Street 2:4700 WATERS AVENUE CLARK TERRACE SUITE 25
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2968
Mailing Address - Country:US
Mailing Address - Phone:912-350-6580
Mailing Address - Fax:912-350-6575
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8068
Practice Address - Fax:912-350-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00864872AMedicaid
930950OtherBLUE CROSS OF GA
SCAB0053Medicaid
SCAB0053Medicaid