Provider Demographics
NPI:1306435193
Name:REGIONAL MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:REGIONAL MEDICAL TRANSPORT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-839-7110
Mailing Address - Street 1:3377 US ST RT 35 EAST
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381
Mailing Address - Country:US
Mailing Address - Phone:937-839-7110
Mailing Address - Fax:937-839-7024
Practice Address - Street 1:3377 US ST RT 35 EAST
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-4538
Practice Address - Country:US
Practice Address - Phone:937-839-7110
Practice Address - Fax:937-839-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)