Provider Demographics
NPI:1619508512
Name:ANGELIC MEDICAL TRANSPORT SERVICES LLC
Entity Type:Organization
Organization Name:ANGELIC MEDICAL TRANSPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-271-9411
Mailing Address - Street 1:1110 WESTHILLS CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6976
Mailing Address - Country:US
Mailing Address - Phone:480-271-9411
Mailing Address - Fax:
Practice Address - Street 1:1110 WESTHILLS CT
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6976
Practice Address - Country:US
Practice Address - Phone:480-271-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)