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General NPI Number Information
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NPI Number | 1336617034
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL TRANSPORTION
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 4545 FORSYTH RD STE 1
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City | MACON
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State | GA
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Zip | 31210-4527
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Country | US
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Telephone | 478-337-5202
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Fax | 478-215-0415
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Provider Business Mailing Address
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Address Line | 7040 PEAKE RD N PO BOX 28378
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City | MACON
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State | GA
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Zip | 31210-8689
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Country | US
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Telephone | 478-337-5202
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Fax | 478-215-0415
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Authorized Official
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Title or Position | OWNER
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Name | KRISTY N MCCORKLE
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Credential |
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Telephone | 478-719-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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