Healthcare Provider Details

I. General information

NPI: 1356639801
Provider Name (Legal Business Name): FRIENDLY MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 03/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 MANDY LANE
MOREHEAD CITY NC
28557-3276
US

IV. Provider business mailing address

3402 MANDY LANE
MOREHEAD CITY NC
28557-3276
US

V. Phone/Fax

Practice location:
  • Phone: 252-808-3400
  • Fax: 252-808-3403
Mailing address:
  • Phone: 252-808-3400
  • Fax: 252-808-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NATHAN AWALT
Title or Position: DIRECTOR
Credential:
Phone: 252-808-3400