Provider Demographics
NPI:1609068741
Name:GHOST MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:GHOST MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:B ALI
Authorized Official - Last Name:FATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-909-7701
Mailing Address - Street 1:6821 CARNATION ST APT F
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5264
Mailing Address - Country:US
Mailing Address - Phone:804-909-7701
Mailing Address - Fax:804-745-0295
Practice Address - Street 1:6821 CARNATION ST APT F
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5264
Practice Address - Country:US
Practice Address - Phone:804-909-7701
Practice Address - Fax:804-745-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAKJW3564343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)