Healthcare Provider Details

I. General information

NPI: 1215875232
Provider Name (Legal Business Name): MEDI RUN VAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 RUSSELL PKWY STE 18
WARNER ROBINS GA
31088-8680
US

IV. Provider business mailing address

4501 RUSSELL PKWY STE 18
WARNER ROBINS GA
31088-8680
US

V. Phone/Fax

Practice location:
  • Phone: 478-287-6585
  • Fax:
Mailing address:
  • Phone: 478-287-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JACOB STEWART
Title or Position: CEO
Credential:
Phone: 478-287-6585