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General NPI Number Information
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NPI Number | 1386810307
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Entity Type | Organization
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Legal Business Name | METRO EAST MEDICAL TRANSPORT, INC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 7720 STONEBRIDGE GOLF DR
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City | MARYVILLE
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State | IL
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Zip | 62062-6450
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Country | US
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Telephone | 618-623-4582
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Fax | 618-301-3360
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Provider Business Mailing Address
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Address Line | 7720 STONEBRIDGE GOLF DR
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City | MARYVILLE
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State | IL
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Zip | 62062-6450
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Country | US
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Telephone | 618-623-4582
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Fax | 618-301-3360
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | KATHIE KAY GOODWIN
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Credential |
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Telephone | 618-623-4582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 1610314
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License Number State | IL
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