Provider Demographics
NPI:1477878296
Name:GUARDIAN ANGEL MEDICAL TRANSPORT,LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL MEDICAL TRANSPORT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-686-4480
Mailing Address - Street 1:3029 KEMPTON PARK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2552
Mailing Address - Country:US
Mailing Address - Phone:757-686-4480
Mailing Address - Fax:
Practice Address - Street 1:3029 KEMPTON PARK RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2552
Practice Address - Country:US
Practice Address - Phone:757-686-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)