MEDICARE: GUARDIAN MEDICAL TRANSIT, 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
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17347	OTHER	SC	MEDICIAD

General Provider Information

NPI Number	:	1962067173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN MEDICAL TRANSIT, LLC

Provider Business Mailing Address
First Line	:	10838 KINGS RD STE 25
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-6070
Country	:	US
Telephone Number	:	843-457-0725
Fax Number	:

Provider Business Practice Location Address
First Line	:	10838 KINGS RD STE 25
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-6070
Country	:	US
Telephone Number	:	843-457-0725
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KENNETH M. THOMAS
Credential	:	DIRECTOR
Telephone Number	:	843-457-0725

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	07/19/2024

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