Provider Demographics
NPI:1720553092
Name:RELAY MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:RELAY MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAYGBE
Authorized Official - Suffix:
Authorized Official - Credentials:NON EMERGENCY TRANSP
Authorized Official - Phone:704-492-3061
Mailing Address - Street 1:4919 ALBEMARLE RD STE 1014919
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6683
Mailing Address - Country:US
Mailing Address - Phone:704-817-7006
Mailing Address - Fax:704-817-8102
Practice Address - Street 1:4919 ALBEMARLE RD STE 1014919
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6683
Practice Address - Country:US
Practice Address - Phone:704-817-7006
Practice Address - Fax:704-817-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN#