Provider Demographics
NPI:1720214232
Name:PIKE COUNTY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:PIKE COUNTY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-582-0305
Mailing Address - Street 1:4747 N COUNTY ROAD 575 E
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567-8804
Mailing Address - Country:US
Mailing Address - Phone:812-582-0305
Mailing Address - Fax:800-381-9767
Practice Address - Street 1:4747 N COUNTY ROAD 575 E
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-8804
Practice Address - Country:US
Practice Address - Phone:812-582-0305
Practice Address - Fax:800-381-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport