Healthcare Provider Details

I. General information

NPI: 1013246461
Provider Name (Legal Business Name): MEDTRAN EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EXCECUTIVE PARK
LAKE CITY SC
29560
US

IV. Provider business mailing address

392 MCCLAM RD
CADES SC
29518-3302
US

V. Phone/Fax

Practice location:
  • Phone: 757-615-9012
  • Fax:
Mailing address:
  • Phone: 757-615-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAFARA DOZIER
Title or Position: OWNER
Credential:
Phone: 757-615-9012