Provider Demographics
NPI:1497793145
Name:HARRELL MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:HARRELL MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-465-9939
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0208
Mailing Address - Country:US
Mailing Address - Phone:252-465-9939
Mailing Address - Fax:252-465-9995
Practice Address - Street 1:49 MUDDY CROSS RD
Practice Address - Street 2:
Practice Address - City:HOBBSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27946-9586
Practice Address - Country:US
Practice Address - Phone:252-465-9939
Practice Address - Fax:252-465-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406981Medicaid
NC3406981Medicaid