Provider Demographics
NPI:1588176374
Name:DELTA MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:DELTA MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUSGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-824-6098
Mailing Address - Street 1:3404 PHILCO
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5176
Mailing Address - Country:US
Mailing Address - Phone:870-284-6098
Mailing Address - Fax:
Practice Address - Street 1:3404 PHILCO
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-5176
Practice Address - Country:US
Practice Address - Phone:870-284-6098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty