Provider Demographics
NPI:1801925680
Name:ROANOKE MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:ROANOKE MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-789-4950
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:415 EAST BLVD
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1005
Mailing Address - Country:US
Mailing Address - Phone:252-789-4950
Mailing Address - Fax:252-792-0993
Practice Address - Street 1:322 S MCCASKEY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2150
Practice Address - Country:US
Practice Address - Phone:252-789-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05812643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406816Medicaid
NC073CAOtherBCBS
NC=========OtherFEDERAL TAX ID
NC=========OtherFEDERAL TAX ID