Provider Demographics
NPI:1659376788
Name:BRAVEHEART MEDICAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:BRAVEHEART MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-277-8003
Mailing Address - Street 1:303D ATKINSON ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3633
Mailing Address - Country:US
Mailing Address - Phone:910-277-8003
Mailing Address - Fax:910-277-0508
Practice Address - Street 1:303D ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3633
Practice Address - Country:US
Practice Address - Phone:910-277-8003
Practice Address - Fax:910-277-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406684Medicaid
NC2782405Medicare ID - Type Unspecified