Provider Demographics
NPI:1154045433
Name:PRIMECARE MEDICAL TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:PRIMECARE MEDICAL TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TASONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-379-8319
Mailing Address - Street 1:102 E AMHURST ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2201
Mailing Address - Country:US
Mailing Address - Phone:703-232-1450
Mailing Address - Fax:
Practice Address - Street 1:102 E AMHURST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2201
Practice Address - Country:US
Practice Address - Phone:703-232-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)