=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255334819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN MEDICAL TRANSPORT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 W MAIN ST
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-8202
-----------------------------------------------------
Fax | 410-848-2644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 W MAIN ST
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-8202
-----------------------------------------------------
Fax | 410-848-2644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARBARA NOELLE FLOREEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-848-8202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | #113
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------