Provider Demographics
NPI:1669350104
Name:PURE-HEARTED MEDICAL TRANS. LLC
Entity type:Organization
Organization Name:PURE-HEARTED MEDICAL TRANS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:943-227-0357
Mailing Address - Street 1:728 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2418
Mailing Address - Country:US
Mailing Address - Phone:943-227-0357
Mailing Address - Fax:
Practice Address - Street 1:728 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2418
Practice Address - Country:US
Practice Address - Phone:943-227-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)