Provider Demographics
NPI:1497905707
Name:PATRIOT MEDICAL TRANSPORT SYSTEM, LLC
Entity type:Organization
Organization Name:PATRIOT MEDICAL TRANSPORT SYSTEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-290-5202
Mailing Address - Street 1:38588 BRETT WAY
Mailing Address - Street 2:P,O, BOX 403
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-7218
Mailing Address - Country:US
Mailing Address - Phone:301-290-5202
Mailing Address - Fax:301-290-5240
Practice Address - Street 1:38588 BRETT WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-7218
Practice Address - Country:US
Practice Address - Phone:301-290-5202
Practice Address - Fax:301-290-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD.COMM.AMB.LIC#126341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance