Healthcare Provider Details

I. General information

NPI: 1306435193
Provider Name (Legal Business Name): REGIONAL MEDICAL TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 US ST RT 35 EAST
WEST ALEXANDRIA OH
45381-4538
US

IV. Provider business mailing address

3377 US ST RT 35 EAST
WEST ALEXANDRIA OH
45381
US

V. Phone/Fax

Practice location:
  • Phone: 937-839-7110
  • Fax: 937-839-7024
Mailing address:
  • Phone: 937-839-7110
  • Fax: 937-839-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WENDELL E MACKIE
Title or Position: CO-OWNER
Credential:
Phone: 937-839-7110