Provider Demographics
NPI:1619467123
Name:QUALITY MED TRANSPORT, INC.
Entity Type:Organization
Organization Name:QUALITY MED TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:954-632-0411
Mailing Address - Street 1:3515 N CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9714
Mailing Address - Country:US
Mailing Address - Phone:217-607-2468
Mailing Address - Fax:309-403-6206
Practice Address - Street 1:3515 N CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-9714
Practice Address - Country:US
Practice Address - Phone:217-607-2468
Practice Address - Fax:309-403-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker