Organization
MOBILE LIFE TRANSPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA L MCDERMOTT (SOLE MEMBER)
(607) 674-9600
Entity
Organization
Contact information
Practice address
7918 STATE HIGHWAY 12, SHERBURNE, NY 13460-2902
(607) 674-9600
(607) 674-9601
Mailing address
7918 STATE HIGHWAY 12, SHERBURNE, NY 13460-2902
(607) 674-9600
(607) 674-9601
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
38095
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03297349
—
NY
Enumeration date
02/20/2017
Last updated
02/20/2017
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