Provider Demographics
NPI:1912709650
Name:MED ATLANTIC MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:MED ATLANTIC MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RASHAWN
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-615-2122
Mailing Address - Street 1:621 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3841
Mailing Address - Country:US
Mailing Address - Phone:843-615-2122
Mailing Address - Fax:843-944-0511
Practice Address - Street 1:621 PEARL ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3841
Practice Address - Country:US
Practice Address - Phone:843-615-2122
Practice Address - Fax:843-944-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport