Provider Demographics
NPI:1902191596
Name:MEDICAL TRANSPORT MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MEDICAL TRANSPORT MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DINTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:870-538-3900
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-0844
Mailing Address - Country:US
Mailing Address - Phone:870-538-3900
Mailing Address - Fax:870-538-3902
Practice Address - Street 1:111 W PEDDICORD ST
Practice Address - Street 2:
Practice Address - City:DERMOTT
Practice Address - State:AR
Practice Address - Zip Code:71638-2115
Practice Address - Country:US
Practice Address - Phone:870-538-3900
Practice Address - Fax:870-538-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport