MEDICARE: PRIME MEDICAL TRANSPORT LLC

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)

General Provider Information

NPI Number	:	1831036169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	3122 KIRKWOOD DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-2354
Country	:	US
Telephone Number	:	678-668-9160
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 KIRKWOOD DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-2354
Country	:	US
Telephone Number	:	678-668-9160
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAGGIE POUR
Credential	:
Telephone Number	:	678-668-9160

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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