Provider Demographics
NPI:1528607207
Name:MEDICAID TRAVEL, INC.
Entity Type:Organization
Organization Name:MEDICAID TRAVEL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-737-0734
Mailing Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:919-737-0734
Mailing Address - Fax:216-250-8369
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:919-737-0734
Practice Address - Fax:216-250-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No174200000XOther Service ProvidersMeals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)