=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053304287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL CARE TRANSPORTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 08/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 794 HIGHWAY 29 N
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30263-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-304-2273
-----------------------------------------------------
Fax | 770-304-1176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1831 794 N HWY 29
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30264-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-304-2273
-----------------------------------------------------
Fax | 770-304-1176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | RENEE MOORE HUNTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-254-0866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 03803
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------