Provider Demographics
NPI:1659529626
Name:SOUTHERN MEDICAL TRANSPORT SERVICE INC
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL TRANSPORT SERVICE INC
Other - Org Name:SOUTHERN MEDICAL TRANSPORTATION SERVICES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ROSEKRANS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:1757-338-1681
Mailing Address - Street 1:3813 POINT ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5724
Mailing Address - Country:US
Mailing Address - Phone:757-338-1681
Mailing Address - Fax:757-295-9765
Practice Address - Street 1:3813 POINT ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5724
Practice Address - Country:US
Practice Address - Phone:757-338-1681
Practice Address - Fax:757-295-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1199341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659529626Medicaid
VA1659529626Medicaid