Provider Demographics
NPI:1851321160
Name:PRIMECARE MEDICAL TRANSPORT, LLC.
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL TRANSPORT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-422-0900
Mailing Address - Street 1:568 MILFORD HARRINGTON HWY
Mailing Address - Street 2:P.O. BOX 839
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5306
Mailing Address - Country:US
Mailing Address - Phone:302-422-0900
Mailing Address - Fax:302-422-1082
Practice Address - Street 1:568 MILFORD HARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5306
Practice Address - Country:US
Practice Address - Phone:302-422-0900
Practice Address - Fax:302-422-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19971132383416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0461460000OtherAMERIHEALTH
DE0000788215Medicaid
CT81-00547OtherEVERCARE
DE00007731715Medicaid
DE0461460000OtherAMERIHEALTH