Provider Demographics
NPI:1497443139
Name:EVOLUTION NON EMERGENCY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:EVOLUTION NON EMERGENCY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-889-7137
Mailing Address - Street 1:73 GARDEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2215
Mailing Address - Country:US
Mailing Address - Phone:443-889-7137
Mailing Address - Fax:
Practice Address - Street 1:73 GARDEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2215
Practice Address - Country:US
Practice Address - Phone:443-889-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)