Provider Demographics
NPI:1245854280
Name:CONQUEST MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:CONQUEST MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-259-2896
Mailing Address - Street 1:182 RILEY AVE STE F1
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-0777
Mailing Address - Country:US
Mailing Address - Phone:478-259-2896
Mailing Address - Fax:
Practice Address - Street 1:182 RILEY AVE STE F1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-0777
Practice Address - Country:US
Practice Address - Phone:478-259-2896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance