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General NPI Number Information
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NPI Number | 1518581503
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Entity Type | Organization
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Legal Business Name | GUARDIAN MEDICAL TRANSPORTATION LLC,
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 5950 OLD PORTER RD APT 302
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City | PORTAGE
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State | IN
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Zip | 46368-1555
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Country | US
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Telephone | 219-200-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 5950 OLD PORTER RD APT 302
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City | PORTAGE
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State | IN
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Zip | 46368-1555
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Country | US
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Telephone | 219-200-9421
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. CALVIN LEE MAGEE JR.
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Credential |
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Telephone | 219-200-9422
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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 |
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License Number State |
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