Provider Demographics
NPI:1821460502
Name:MEDSTAR MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:MEDSTAR MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-7827
Mailing Address - Street 1:1322 BROUGHTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6979
Mailing Address - Country:US
Mailing Address - Phone:843-669-7827
Mailing Address - Fax:843-669-3279
Practice Address - Street 1:1322 BROUGHTON BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6979
Practice Address - Country:US
Practice Address - Phone:843-669-7827
Practice Address - Fax:843-669-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2011993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport