Provider Demographics
NPI:1467779025
Name:SELECT NATIONAL MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SELECT NATIONAL MEDICAL TRANSPORT LLC
Other - Org Name:SELECT MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUSUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-337-3808
Mailing Address - Street 1:220 BARREN SPRINGS
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-5924
Mailing Address - Country:US
Mailing Address - Phone:281-337-3808
Mailing Address - Fax:
Practice Address - Street 1:220 BARREN SPRINGS
Practice Address - Street 2:SUITE 9
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-5924
Practice Address - Country:US
Practice Address - Phone:281-337-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport