Provider Demographics
NPI:1184495822
Name:ALBEMARLE MEDICAL TRANSPORT INC.
Entity type:Organization
Organization Name:ALBEMARLE MEDICAL TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:MCKECUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-339-1922
Mailing Address - Street 1:417 S HUGHES BLVD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CTY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4526
Mailing Address - Country:US
Mailing Address - Phone:252-339-1922
Mailing Address - Fax:
Practice Address - Street 1:417 S HUGHES BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4526
Practice Address - Country:US
Practice Address - Phone:252-339-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)