Healthcare Provider Details

I. General information

NPI: 1174615991
Provider Name (Legal Business Name): MOUNTAIN TRANSIT AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 BROAD STREET
SUMMERSVILLE WV
26651-1739
US

IV. Provider business mailing address

1096 BROAD STREET
SUMMERSVILLE WV
26651-1739
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-5872
  • Fax: 304-872-5877
Mailing address:
  • Phone: 304-872-5872
  • Fax: 304-872-5877

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: DAVID L JOHNSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 304-872-5872