Provider Demographics
NPI:1750611034
Name:PROFESSIONAL MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-345-6666
Mailing Address - Street 1:5935 HENNINGER DRIVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1218
Mailing Address - Country:US
Mailing Address - Phone:402-345-6666
Mailing Address - Fax:402-731-6302
Practice Address - Street 1:2403 TOWLE ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-1563
Practice Address - Country:US
Practice Address - Phone:402-345-6666
Practice Address - Fax:402-731-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport