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General NPI Number Information
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NPI Number | 1922468909
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Entity Type | Organization
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Legal Business Name | PRINCE GEORGE TRANSPORT
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 200 LOUTHIAN WAY
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City | BLYTHEWOOD
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State | SC
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Zip | 29016
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Country | US
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Telephone | 803-231-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LOUTHIAN WAY
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7902
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Country | US
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Telephone | 803-213-9420
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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. GRAHAM H SCHMIDT I
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Credential | EMTB
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Telephone | 803-231-9420
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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 | SC024461
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | E3044851
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License Number State | SC
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