Provider Demographics
NPI:1003870072
Name:BRAVEHEART MEDICAL TRANSPORT, INC
Entity type:Organization
Organization Name:BRAVEHEART MEDICAL TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:910-277-8003
Mailing Address - Street 1:PO BOX 25863
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5863
Mailing Address - Country:US
Mailing Address - Phone:910-277-8003
Mailing Address - Fax:910-277-0508
Practice Address - Street 1:114 JOHN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3030
Practice Address - Country:US
Practice Address - Phone:910-277-8003
Practice Address - Fax:910-277-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
NC13813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0720QOtherBCBS
NC3406684Medicaid
NC3406684Medicaid