Provider Demographics
NPI:1720482334
Name:MOUNTAIN EMPIRE MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:MOUNTAIN EMPIRE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ALIC
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MPM
Authorized Official - Phone:843-513-3515
Mailing Address - Street 1:320 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2970
Mailing Address - Country:US
Mailing Address - Phone:843-513-3515
Mailing Address - Fax:
Practice Address - Street 1:320 ABBEY RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2970
Practice Address - Country:US
Practice Address - Phone:843-513-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle