Healthcare Provider Details

I. General information

NPI: 1205118585
Provider Name (Legal Business Name): NMS MEDICAL TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2618 WILDWOOD AVE
JACKSON MI
49202-3931
US

IV. Provider business mailing address

2618 WILDWOOD AVE
JACKSON MI
49202-3931
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0248
  • Fax: 517-768-9760
Mailing address:
  • Phone: 517-768-0248
  • Fax: 517-768-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL2698
License Number StateMI

VIII. Authorized Official

Name: CHARLES LARRY GILLILAND
Title or Position: OWNER
Credential:
Phone: 517-768-9760