Provider Demographics
NPI:1285135806
Name:SUMMIT MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:SUMMIT MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-343-8788
Mailing Address - Street 1:100 LIBERTY ST STE B
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1194
Mailing Address - Country:US
Mailing Address - Phone:470-592-2157
Mailing Address - Fax:
Practice Address - Street 1:100 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1194
Practice Address - Country:US
Practice Address - Phone:678-343-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport