Provider Demographics
NPI:1750674941
Name:LOGAN MEDICAL TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:LOGAN MEDICAL TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-203-8879
Mailing Address - Street 1:5401 SOUTH BLVD STE A
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2741
Mailing Address - Country:US
Mailing Address - Phone:704-512-0770
Mailing Address - Fax:
Practice Address - Street 1:10804 AZURE VALLEY PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-9958
Practice Address - Country:US
Practice Address - Phone:704-512-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24085411343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)