Provider Demographics
NPI:1700476058
Name:GUARDIAN ANGELS MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS MEDICAL TRANSPORTATION LLC
Other - Org Name:GUARDIAN TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-922-4165
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-0753
Mailing Address - Country:US
Mailing Address - Phone:803-497-3415
Mailing Address - Fax:803-753-9053
Practice Address - Street 1:1681 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-3327
Practice Address - Country:US
Practice Address - Phone:803-497-3415
Practice Address - Fax:803-753-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC613OtherDHEC