Provider Demographics
NPI:1215347968
Name:MED ATLANTIC
Entity type:Organization
Organization Name:MED ATLANTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-601-5423
Mailing Address - Street 1:901 S SANTIAGO DR STE UNITJ
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6091
Mailing Address - Country:US
Mailing Address - Phone:843-601-5423
Mailing Address - Fax:
Practice Address - Street 1:901 S SANTIAGO DR STE UNITJ
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6091
Practice Address - Country:US
Practice Address - Phone:843-601-5423
Practice Address - Fax:864-751-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)