Provider Demographics
NPI:1871589937
Name:MID-MARYLAND MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:MID-MARYLAND MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HEISEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-5260
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-8060
Mailing Address - Country:US
Mailing Address - Phone:866-553-4220
Mailing Address - Fax:540-536-4359
Practice Address - Street 1:930 ELDRIDGE DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6859
Practice Address - Country:US
Practice Address - Phone:301-733-6655
Practice Address - Fax:301-733-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015107600Medicaid
385544OtherTRIGO
7667189OtherAETNA CHOICE
590014790OtherRAILROAD MEDICARE
90142127OtherVA MEDICAID
2473443OtherAETNA BLUE BELL HMO
TR68MIOtherBS MARYLAND
WV800301700Medicaid
2110905OtherMAMSI
590014790OtherRAILROAD MEDICARE
=========OtherUNITED HEALTH CARE
WV800301700Medicaid
2110905OtherMAMSI
MD015107600Medicaid
=========OtherCHAMPUS
2473443OtherAETNA BLUE BELL HMO
=========OtherFREDERICK PHYSICIAN NTWK