Healthcare Provider Details

I. General information

NPI: 1043134083
Provider Name (Legal Business Name): PRIMECARE MEDICAL TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RENEE LN
TIFFIN IA
52340-4756
US

IV. Provider business mailing address

24 RENEE LN
TIFFIN IA
52340-4756
US

V. Phone/Fax

Practice location:
  • Phone: 207-409-0895
  • Fax:
Mailing address:
  • Phone: 207-409-0895
  • 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: ERIK MARANGO
Title or Position: MANAGER
Credential:
Phone: 207-409-0895