Provider Demographics
NPI:1790524940
Name:COUNTRYSIDE MEDICAL TRANSIT, LLC
Entity type:Organization
Organization Name:COUNTRYSIDE MEDICAL TRANSIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-405-9787
Mailing Address - Street 1:979 N STATE ROUTE 589
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:OH
Mailing Address - Zip Code:45317-9500
Mailing Address - Country:US
Mailing Address - Phone:937-405-9787
Mailing Address - Fax:
Practice Address - Street 1:979 N STATE ROUTE 589
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:OH
Practice Address - Zip Code:45317-9500
Practice Address - Country:US
Practice Address - Phone:937-405-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle