Provider Demographics
NPI:1821091471
Name:CAVALRY MEDICAL TRANSPORT,INC
Entity Type:Organization
Organization Name:CAVALRY MEDICAL TRANSPORT,INC
Other - Org Name:CAVALRY MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF BENEFITS AND RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:336-725-1031
Mailing Address - Street 1:1095 FAIRCHILD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4525
Mailing Address - Country:US
Mailing Address - Phone:336-725-1031
Mailing Address - Fax:336-725-9191
Practice Address - Street 1:1095 FAIRCHILD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4525
Practice Address - Country:US
Practice Address - Phone:336-725-1031
Practice Address - Fax:336-725-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1561341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406842Medicaid
NC55162Medicare UPIN
NC3406842Medicaid