Provider Demographics
NPI:1568716231
Name:1ST MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:1ST MEDICAL TRANSPORT LLC
Other - Org Name:1ST MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CONNELL
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-595-4814
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-0483
Mailing Address - Country:US
Mailing Address - Phone:478-595-4814
Mailing Address - Fax:
Practice Address - Street 1:1406 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-2632
Practice Address - Country:US
Practice Address - Phone:478-595-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport