Provider Demographics
NPI:1942683883
Name:MOUNTAIN PRIDE TRANSPORT,LLC
Entity Type:Organization
Organization Name:MOUNTAIN PRIDE TRANSPORT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:LAHART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-703-7314
Mailing Address - Street 1:1120 TOM MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27053-7214
Mailing Address - Country:US
Mailing Address - Phone:336-703-7314
Mailing Address - Fax:
Practice Address - Street 1:1120 TOM MARTIN RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NC
Practice Address - Zip Code:27053-7214
Practice Address - Country:US
Practice Address - Phone:336-703-7314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)