Provider Demographics
NPI:1053023374
Name:MEDUPORT TRANSPORTATIONS
Entity type:Organization
Organization Name:MEDUPORT TRANSPORTATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-729-9988
Mailing Address - Street 1:PO BOX 50441
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0441
Mailing Address - Country:US
Mailing Address - Phone:843-729-2862
Mailing Address - Fax:
Practice Address - Street 1:4995 BALLANTINE DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9009
Practice Address - Country:US
Practice Address - Phone:843-729-2862
Practice Address - Fax:843-771-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)