Provider Demographics
NPI:1528742905
Name:VITAL MEDICAL TRANSPORT SERVICES, LLC.
Entity type:Organization
Organization Name:VITAL MEDICAL TRANSPORT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMONE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-381-0026
Mailing Address - Street 1:25 SLATE CREEK DR APT 6
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2923
Mailing Address - Country:US
Mailing Address - Phone:716-381-0026
Mailing Address - Fax:
Practice Address - Street 1:25 SLATE CREEK DR APT 6
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2923
Practice Address - Country:US
Practice Address - Phone:716-381-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)