Provider Demographics
NPI:1578916003
Name:EXECUTIVE MEDICAL TRANSPORTATION, LTD
Entity Type:Organization
Organization Name:EXECUTIVE MEDICAL TRANSPORTATION, LTD
Other - Org Name:EXECUTIVE MEDICAL TRANSPORTATION, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TRANSPORT DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCRETIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-501-5189
Mailing Address - Street 1:6938 FAUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7529
Mailing Address - Country:US
Mailing Address - Phone:240-501-5189
Mailing Address - Fax:803-569-6735
Practice Address - Street 1:222 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:POLLOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28573-9312
Practice Address - Country:US
Practice Address - Phone:240-501-5189
Practice Address - Fax:803-569-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC273Y00000X, 3416L0300X, 343800000X, 343900000X, 344600000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No273Y00000XHospital UnitsRehabilitation Unit
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347E00000XTransportation ServicesTransportation Broker