Healthcare Provider Details

I. General information

NPI: 1376962928
Provider Name (Legal Business Name): PREMIAER CARE MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MADISON LN
SICKLERVILLE NJ
08081-4410
US

IV. Provider business mailing address

17 MADISON LN
SICKLERVILLE NJ
08081-4410
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-2273
  • Fax: 856-875-2275
Mailing address:
  • Phone: 856-875-2273
  • Fax: 856-875-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100694
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number100694
License Number StateNJ

VIII. Authorized Official

Name: MR. DELVIN JAMES CHARLESTON
Title or Position: OWNER
Credential:
Phone: 609-254-3107