Provider Demographics
NPI:1356964241
Name:MEDTRIPS OF THE CAROLINAS LLC
Entity type:Organization
Organization Name:MEDTRIPS OF THE CAROLINAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:W
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-254-7087
Mailing Address - Street 1:7137 BADENOCH CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3483
Mailing Address - Country:US
Mailing Address - Phone:980-254-7087
Mailing Address - Fax:
Practice Address - Street 1:5250 FEWELL RD
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-7012
Practice Address - Country:US
Practice Address - Phone:980-254-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)