MEDICARE: REGIONAL 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1912675232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL MEDICAL TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	71 1/2 N MAIN ST
Second Line	:
City	:	WEST ALEXANDRIA
State	:	OH
Zip	:	45381-1153
Country	:	US
Telephone Number	:	937-839-7110
Fax Number	:	937-839-7024

Provider Business Practice Location Address
First Line	:	71 1/2 N MAIN ST
Second Line	:
City	:	WEST ALEXANDRIA
State	:	OH
Zip	:	45381-1153
Country	:	US
Telephone Number	:	937-839-7110
Fax Number	:	937-839-7024

Authorized Official
Title or Position	:	OWNER
Name	:	WENDELL E MACKIE
Credential	:
Telephone Number	:	937-533-8854

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	05/16/2023

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