Provider Demographics
NPI:1902399611
Name:OLIVE BRANCH NON-EMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:OLIVE BRANCH NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:OLIVE BRANCH TRANSPORTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-475-9861
Mailing Address - Street 1:1300 FAYETTE ST APT 199
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1360
Mailing Address - Country:US
Mailing Address - Phone:267-475-9861
Mailing Address - Fax:
Practice Address - Street 1:1300 FAYETTE ST APT 199
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1360
Practice Address - Country:US
Practice Address - Phone:267-475-9861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA730434343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)