Provider Demographics
NPI:1972311835
Name:SUMMIT MEDICAL TRANSPORTATION. LLC
Entity type:Organization
Organization Name:SUMMIT MEDICAL TRANSPORTATION. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OKETCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-777-2787
Mailing Address - Street 1:9734 TAPESTRY PARK CIR APT 480
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9950
Mailing Address - Country:US
Mailing Address - Phone:605-777-2787
Mailing Address - Fax:
Practice Address - Street 1:9734 TAPESTRY PARK CIR APT 480
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9950
Practice Address - Country:US
Practice Address - Phone:605-777-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)