Provider Demographics
NPI:1790041366
Name:PIPER MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:PIPER MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-997-1142
Mailing Address - Street 1:2793 HIGHWAY 82 S
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-5104
Mailing Address - Country:US
Mailing Address - Phone:678-997-1142
Mailing Address - Fax:706-367-9753
Practice Address - Street 1:2793 HIGHWAY 82 S
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-5104
Practice Address - Country:US
Practice Address - Phone:678-997-1142
Practice Address - Fax:706-367-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMCA606804343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)