Provider Demographics
NPI:1700441284
Name:MEDI PORT TRANSPORATION LLC
Entity Type:Organization
Organization Name:MEDI PORT TRANSPORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-410-5836
Mailing Address - Street 1:1121 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-8787
Mailing Address - Country:US
Mailing Address - Phone:601-410-5836
Mailing Address - Fax:888-449-9560
Practice Address - Street 1:1121 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-8787
Practice Address - Country:US
Practice Address - Phone:601-410-5836
Practice Address - Fax:888-449-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)