MEDICARE: ALBEMARLE MEDICAL TRANSPORT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1184495822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE MEDICAL TRANSPORT INC.

Provider Business Mailing Address
First Line	:	417 S HUGHES BLVD
Second Line	:
City	:	ELIZABETH CTY
State	:	NC
Zip	:	27909-4526
Country	:	US
Telephone Number	:	252-339-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 S HUGHES BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4526
Country	:	US
Telephone Number	:	252-339-1922
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRENT JAMISON MCKECUEN
Credential	:
Telephone Number	:	252-339-1922

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	07/08/2024

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