Provider Demographics
NPI:1790261642
Name:MINE HILL MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:MINE HILL MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAMPEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-989-5185
Mailing Address - Street 1:195 ROUTE 46 WEST SUITE 201
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:RI
Mailing Address - Zip Code:07803
Mailing Address - Country:US
Mailing Address - Phone:973-989-5185
Mailing Address - Fax:973-328-4097
Practice Address - Street 1:195 ROUTE 46 WEST SUITE 201
Practice Address - Street 2:
Practice Address - City:MINE HILL
Practice Address - State:RI
Practice Address - Zip Code:07803
Practice Address - Country:US
Practice Address - Phone:973-989-5185
Practice Address - Fax:973-328-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)