Provider Demographics
NPI:1659905438
Name:EN ROUTE MEDICAL CHARLOTTE
Entity Type:Organization
Organization Name:EN ROUTE MEDICAL CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-724-4988
Mailing Address - Street 1:11406 PEDIGREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1594
Mailing Address - Country:US
Mailing Address - Phone:704-724-4988
Mailing Address - Fax:
Practice Address - Street 1:11406 PEDIGREE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1594
Practice Address - Country:US
Practice Address - Phone:704-724-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)