Provider Demographics
NPI:1497397038
Name:ELMORE, LATRON
Entity Type:Individual
Prefix:
First Name:LATRON
Middle Name:
Last Name:ELMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 HARDING DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-8801
Mailing Address - Country:US
Mailing Address - Phone:910-627-6238
Mailing Address - Fax:
Practice Address - Street 1:360 ISLAND RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-8676
Practice Address - Country:US
Practice Address - Phone:910-627-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)