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General NPI Number Information
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NPI Number | 1659063063
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Entity Type | Organization
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Legal Business Name | SECUREMED TRANSPORT LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 113 S PERRY ST STE 206
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4811
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Country | US
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Telephone | 706-594-5479
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Fax |
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Provider Business Mailing Address
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Address Line | 113 S PERRY ST STE 206
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4811
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Country | US
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Telephone | 706-594-3736
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TERRANCE BANKS
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Credential |
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Telephone | 706-594-5479
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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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