Provider Demographics
NPI:1386344554
Name:PRIME CARE MEDICAL TRANSPORTATION, LLC
Entity type:Organization
Organization Name:PRIME CARE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS-WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-682-9804
Mailing Address - Street 1:120 DALLAS LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-9779
Mailing Address - Country:US
Mailing Address - Phone:704-682-9804
Mailing Address - Fax:
Practice Address - Street 1:120 DALLAS LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-9779
Practice Address - Country:US
Practice Address - Phone:704-682-9804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40432391Medicaid
NC7752D-FD6C56C6OtherSTRETCHER SERVICES