Provider Demographics
NPI:1265180103
Name:STRATEGIC MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:STRATEGIC MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEVILLE
Authorized Official - Middle Name:LASHE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-573-3622
Mailing Address - Street 1:W175N11117 STONEWOOD DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6505
Mailing Address - Country:US
Mailing Address - Phone:262-295-7111
Mailing Address - Fax:
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 108
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6505
Practice Address - Country:US
Practice Address - Phone:262-295-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle