Provider Demographics
NPI:1881944635
Name:EXECUTIVE TRANS-MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:EXECUTIVE TRANS-MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-493-2388
Mailing Address - Street 1:23483 KARR RD
Mailing Address - Street 2:POB 0785
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9341
Mailing Address - Country:US
Mailing Address - Phone:734-493-2388
Mailing Address - Fax:734-461-2612
Practice Address - Street 1:23483 KARR RD
Practice Address - Street 2:POB 0785
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-9341
Practice Address - Country:US
Practice Address - Phone:734-493-2388
Practice Address - Fax:734-461-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)