Provider Demographics
NPI:1962273532
Name:AZALEA MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:AZALEA MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCGANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-256-9732
Mailing Address - Street 1:403 OAKTON TER NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1420
Mailing Address - Country:US
Mailing Address - Phone:614-256-9732
Mailing Address - Fax:207-804-7053
Practice Address - Street 1:403 OAKTON TER NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1420
Practice Address - Country:US
Practice Address - Phone:614-256-9732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance