Provider Demographics
NPI:1962053983
Name:SECURE MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:SECURE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-229-2080
Mailing Address - Street 1:3285 HIGHWAY 1045
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-7239
Mailing Address - Country:US
Mailing Address - Phone:985-507-0368
Mailing Address - Fax:
Practice Address - Street 1:3285 HIGHWAY 1045
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-7239
Practice Address - Country:US
Practice Address - Phone:985-507-0368
Practice Address - Fax:215-358-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)