Healthcare Provider Details

I. General information

NPI: 1326617283
Provider Name (Legal Business Name): MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N MAIN AVE
GRESHAM OR
97030-7244
US

IV. Provider business mailing address

532 N MAIN AVE
GRESHAM OR
97030-7244
US

V. Phone/Fax

Practice location:
  • Phone: 360-339-2792
  • Fax:
Mailing address:
  • Phone: 360-339-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: CHLOE TAYLOR
Title or Position: CO-FOUNDER
Credential:
Phone: 360-339-2792