Provider Demographics
NPI:1912691676
Name:GOLD MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:GOLD MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MSW
Authorized Official - Phone:304-741-0051
Mailing Address - Street 1:1611 FRANKLIN AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2150
Mailing Address - Country:US
Mailing Address - Phone:304-741-0051
Mailing Address - Fax:
Practice Address - Street 1:1611 FRANKLIN AVE
Practice Address - Street 2:APT D
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311
Practice Address - Country:US
Practice Address - Phone:304-741-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)