Provider Demographics
NPI:1659024438
Name:501 NON-EMERGENCY MEDICAL CENTRAL TRANSIT, LLC.
Entity Type:Organization
Organization Name:501 NON-EMERGENCY MEDICAL CENTRAL TRANSIT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANQUINETTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:NEMT
Authorized Official - Phone:501-404-0666
Mailing Address - Street 1:911 CHESTNUT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4301
Mailing Address - Country:US
Mailing Address - Phone:501-404-0666
Mailing Address - Fax:
Practice Address - Street 1:911 CHESTNUT ST STE 5
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4301
Practice Address - Country:US
Practice Address - Phone:501-404-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNEMTMedicaid