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General NPI Number Information
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NPI Number | 1992115075
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Entity Type | Organization
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Legal Business Name | PREMIER CARE MEDICAL TRANSPORT LLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 17 MADISON LN
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-4410
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Country | US
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Telephone | 609-949-1082
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Fax | 856-875-2275
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Provider Business Mailing Address
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Address Line | 17 MADISON LN
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-4410
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Country | US
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Telephone | 609-949-1082
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Fax | 856-875-2275
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Authorized Official
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Title or Position | PRESIDENT
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Name | DELVIN J CHARLESTON
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Credential |
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Telephone | 609-949-1082
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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 | 100694
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License Number State | NJ
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