Basic Information
| Provider Information | |||||||||
| NPI: | 1871589937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-MARYLAND MEDICAL TRANSPORT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1910 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226048060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665534220 | ||||||||
| FaxNumber: | 5405364359 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 ELDRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217406859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017336655 | ||||||||
| FaxNumber: | 3017334229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEISEY | ||||||||
| AuthorizedOfficialFirstName: | M | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5405365260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 015107600 | 05 | MD | MEDICAID | 385544 | 01 | TRIGO | OTHER | 7667189 | 01 | AETNA CHOICE | OTHER | 590014790 | 01 | RAILROAD MEDICARE | OTHER | 90142127 | 01 | VA MEDICAID | OTHER | 2473443 | 01 | AETNA BLUE BELL HMO | OTHER | TR68MI | 01 | BS MARYLAND | OTHER | 800301700 | 05 | WV | MEDICAID | 2110905 | 01 | MAMSI | OTHER |