Healthcare Provider Details

I. General information

NPI: 1427833706
Provider Name (Legal Business Name): SELECT MEDICAL TRANSPORTATION , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 CLAIM JUMPER TRL
WINSTON SALEM NC
27127-8007
US

IV. Provider business mailing address

1972 CLAIM JUMPER TRL
WINSTON SALEM NC
27127-8007
US

V. Phone/Fax

Practice location:
  • Phone: 336-528-8942
  • Fax:
Mailing address:
  • Phone: 336-528-8942
  • Fax:

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 Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CEMETRIUS TEOUNA ROLLE
Title or Position: OWNER/OPERATOR
Credential:
Phone: 336-528-8942