Provider Demographics
NPI:1336617034
Name:PREMIER MEDICAL TRANSPORTION
Entity Type:Organization
Organization Name:PREMIER MEDICAL TRANSPORTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCCORKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-719-7323
Mailing Address - Street 1:7040 PEAKE RD N
Mailing Address - Street 2:PO BOX 28378
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8689
Mailing Address - Country:US
Mailing Address - Phone:478-337-5202
Mailing Address - Fax:478-215-0415
Practice Address - Street 1:4545 FORSYTH RD STE 1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4527
Practice Address - Country:US
Practice Address - Phone:478-337-5202
Practice Address - Fax:478-215-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport