Provider Demographics
NPI:1679111751
Name:MEDICAL TRANSPORT OF ALABAMA
Entity Type:Organization
Organization Name:MEDICAL TRANSPORT OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-744-7475
Mailing Address - Street 1:5600 SHIRLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-3402
Mailing Address - Country:US
Mailing Address - Phone:727-271-8611
Mailing Address - Fax:205-744-3829
Practice Address - Street 1:5600 SHIRLEY PARK DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-3402
Practice Address - Country:US
Practice Address - Phone:727-271-8611
Practice Address - Fax:205-744-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106Medicaid