Healthcare Provider Details

I. General information

NPI: 1437614112
Provider Name (Legal Business Name): DEPENDABLE MEDICAL TRANSSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DURR ROAD
JEFFERSONVILLE NY
12748-0678
US

IV. Provider business mailing address

PO BOX 678
JEFFERSONVILLE NY
12748-0678
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-2128
  • Fax:
Mailing address:
  • Phone: 845-482-2128
  • 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: JOHN GOODFRIEND
Title or Position: OWNER
Credential: OWNER
Phone: 845-482-2128