Healthcare Provider Details

I. General information

NPI: 1013832179
Provider Name (Legal Business Name): MEDI TRANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2443
US

IV. Provider business mailing address

PO BOX 2294
CAPE GIRARDEAU MO
63702-2294
US

V. Phone/Fax

Practice location:
  • Phone: 573-270-6152
  • Fax:
Mailing address:
  • Phone: 573-270-6152
  • 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: MR. ROBERT FOOTE
Title or Position: MANAGER
Credential:
Phone: 573-270-6152