Provider Demographics
NPI:1215286935
Name:TRIAD MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:TRIAD MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-793-8777
Mailing Address - Street 1:3635 REYNOLDA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2258
Mailing Address - Country:US
Mailing Address - Phone:336-793-8777
Mailing Address - Fax:336-419-8777
Practice Address - Street 1:3635 REYNOLDA RD
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2258
Practice Address - Country:US
Practice Address - Phone:336-793-8777
Practice Address - Fax:336-419-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)