Provider Demographics
NPI:1891166799
Name:PRIORITY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:PRIORITY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TREVIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KLEINOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-221-6912
Mailing Address - Street 1:2600 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3466
Mailing Address - Country:US
Mailing Address - Phone:308-221-6912
Mailing Address - Fax:308-221-6914
Practice Address - Street 1:2600 W FRONT ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3466
Practice Address - Country:US
Practice Address - Phone:308-221-6912
Practice Address - Fax:308-221-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-18
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport