Provider Demographics
NPI:1598061582
Name:CABARRUS-MECKLENBURG TRANSPORT, LLC
Entity Type:Organization
Organization Name:CABARRUS-MECKLENBURG TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTEE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:803-524-6978
Mailing Address - Street 1:2604 S RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2852
Mailing Address - Country:US
Mailing Address - Phone:704-262-6914
Mailing Address - Fax:800-886-8442
Practice Address - Street 1:2604 S RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2852
Practice Address - Country:US
Practice Address - Phone:704-262-6914
Practice Address - Fax:800-886-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418940Medicaid