Healthcare Provider Details

I. General information

NPI: 1497098834
Provider Name (Legal Business Name): MED-CARE TRANSPORTATION NORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 FOREST HILLS DR
WHEELING WV
26003-6643
US

IV. Provider business mailing address

34 FOREST HILLS DR
WHEELING WV
26003-6643
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-8804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberWVOEMS
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON MICHAEL TUCKER
Title or Position: VICE PRESIDENT
Credential:
Phone: 304-830-0895