Provider Demographics
NPI:1942796396
Name:WADE MEDICAL TRANSPORTATION SERVICES , LLC
Entity Type:Organization
Organization Name:WADE MEDICAL TRANSPORTATION SERVICES , LLC
Other - Org Name:WADE MEDICAL TRANSPORTATION SERVICE , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEVETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-833-2029
Mailing Address - Street 1:PO BOX 49329
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0077
Mailing Address - Country:US
Mailing Address - Phone:980-833-2029
Mailing Address - Fax:980-545-4415
Practice Address - Street 1:4400 PARK RD UNIT 315
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:980-833-2029
Practice Address - Fax:980-545-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)