Provider Demographics
NPI:1679983555
Name:LIFEPOINTE MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:LIFEPOINTE MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:229-402-1411
Mailing Address - Street 1:PO BOX 1654
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-1654
Mailing Address - Country:US
Mailing Address - Phone:229-402-1411
Mailing Address - Fax:478-216-2015
Practice Address - Street 1:315 PECAN LN
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5330
Practice Address - Country:US
Practice Address - Phone:229-402-1411
Practice Address - Fax:478-216-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)