Provider Demographics
NPI:1538697602
Name:PLAINFIELD MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:PLAINFIELD MEDICAL TRANSPORTATION, LLC
Other - Org Name:PLAINFIELD MEDICAL TRANSPORTATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATSAMOH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-701-0557
Mailing Address - Street 1:PO BOX 4915
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-0915
Mailing Address - Country:US
Mailing Address - Phone:469-701-0557
Mailing Address - Fax:
Practice Address - Street 1:120 ACADIA LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4212
Practice Address - Country:US
Practice Address - Phone:469-701-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)