Provider Demographics
NPI:1154191369
Name:1830 LOGISTICS, LLC
Entity type:Organization
Organization Name:1830 LOGISTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:HEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-285-0373
Mailing Address - Street 1:230 GENE ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-8245
Mailing Address - Country:US
Mailing Address - Phone:140-428-5037
Mailing Address - Fax:
Practice Address - Street 1:230 GENE ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-8245
Practice Address - Country:US
Practice Address - Phone:140-428-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)