Provider Demographics
NPI:1518675123
Name:PRIME MEDICAL TRANSPORTATION INC
Entity type:Organization
Organization Name:PRIME MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-987-7317
Mailing Address - Street 1:3522 US HIGHWAY 70 W # 479
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-8409
Mailing Address - Country:US
Mailing Address - Phone:984-261-6545
Mailing Address - Fax:
Practice Address - Street 1:5301 GOVERNOR SCOTT RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NC
Practice Address - Zip Code:27231-9744
Practice Address - Country:US
Practice Address - Phone:336-987-7317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)