Provider Demographics
NPI:1427833706
Name:SELECT MEDICAL TRANSPORTATION , LLC
Entity type:Organization
Organization Name:SELECT MEDICAL TRANSPORTATION , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMETRIUS
Authorized Official - Middle Name:TEOUNA
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-528-8942
Mailing Address - Street 1:1972 CLAIM JUMPER TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-8007
Mailing Address - Country:US
Mailing Address - Phone:336-528-8942
Mailing Address - Fax:
Practice Address - Street 1:1972 CLAIM JUMPER TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-8007
Practice Address - Country:US
Practice Address - Phone:336-528-8942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle