Healthcare Provider Details

I. General information

NPI: 1063047843
Provider Name (Legal Business Name): TRANSPORTATION WITH MO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST
SAINT PAULS NC
28384-1609
US

IV. Provider business mailing address

PO BOX 852
PARKTON NC
28371-0852
US

V. Phone/Fax

Practice location:
  • Phone: 800-764-0845
  • Fax: 910-745-0705
Mailing address:
  • Phone: 800-764-0845
  • Fax: 910-745-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. MONIQUE AVERY
Title or Position: ADMINISRTATOR
Credential:
Phone: 800-764-0845