Provider Demographics
NPI:1487009270
Name:PREMIER MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-606-9220
Mailing Address - Street 1:8708 RALEIGH MEWS
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-5907
Mailing Address - Country:US
Mailing Address - Phone:571-606-9220
Mailing Address - Fax:571-284-7383
Practice Address - Street 1:8708 RALEIGH MEWS
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-5907
Practice Address - Country:US
Practice Address - Phone:571-606-9220
Practice Address - Fax:571-284-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA382343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)