Provider Demographics
NPI:1285271148
Name:SYNERGY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:SYNERGY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-685-0187
Mailing Address - Street 1:12125 QUEENS CHARTER CT APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5256
Mailing Address - Country:US
Mailing Address - Phone:314-685-0187
Mailing Address - Fax:314-666-8616
Practice Address - Street 1:3675 VAGO LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2374
Practice Address - Country:US
Practice Address - Phone:314-685-0187
Practice Address - Fax:314-666-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)