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General NPI Number Information
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NPI Number | 1871994467
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Entity Type | Organization
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Legal Business Name | CREEK MEDICAL TRANSPORT, INC.
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 3563 QUEEN VICTORIA CT
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City | BEAVERCREEK
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State | OH
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Zip | 45431-5707
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Country | US
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Telephone | 937-286-8482
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Fax |
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Provider Business Mailing Address
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Address Line | 3563 QUEEN VICTORIA COURT
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City | BEAVERCREEK
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State | OH
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Zip | 45431
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Country | US
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Telephone | 937-286-8482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN CLAY MCCLAMMA
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Credential |
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Telephone | 937-286-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | TF925552
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License Number State | OH
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