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General NPI Number Information
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NPI Number | 1649512815
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEDICAL TRANSPORT LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 5282 HIGHWAY 129 SOUTH
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City | CLEVELAND
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State | GA
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Zip | 30528-6761
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Country | US
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Telephone | 706-489-9199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1792
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City | CLEVELAND
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State | GA
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Zip | 30528-0033
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Country | US
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Telephone | 706-489-9199
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ZACHARY PHILYAW
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Credential |
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Telephone | 706-489-9199
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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 | 154-04
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License Number State | GA
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