Provider Demographics
NPI:1891230678
Name:PRIORITY CARE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:PRIORITY CARE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:MARIES DEPAUL
Authorized Official - Last Name:TYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-415-9918
Mailing Address - Street 1:6737 N MILBURN AVE
Mailing Address - Street 2:160-79
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2141
Mailing Address - Country:US
Mailing Address - Phone:559-415-9918
Mailing Address - Fax:
Practice Address - Street 1:6737 N MILBURN AVE
Practice Address - Street 2:160-79
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2141
Practice Address - Country:US
Practice Address - Phone:559-415-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle