Maverick Medical Transport LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

MAVERICK MEDICAL TRANSPORT LLC

Doing business as

Maverick Medical Transport

Practice address

6820 Leslie Lewis Rd
Mullins, SC 29574-5897

Phone

(843) 902-7582

NPI assigned

Jul 23, 2024

Last updated

Jul 23, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Carl Staples Jr., DONPI 1265824809

Title

Com

Phone

(843) 902-7582

Specialties & licenses 1

Addresses

Other names 1

• Maverick Medical Transport Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth Carl Staples Jr., D.O.

  • Emergency Medicine Physician
  • Mullins, SC
  • NPI 1265824809
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1144058934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4690 J H MARTIN RD",
            "city": "GALIVANTS FERRY",
            "state": "SC",
            "postal_code": "295446568",
            "telephone_number": "843-902-7582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6820 LESLIE LEWIS RD",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295745897",
            "telephone_number": "843-902-7582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK MEDICAL TRANSPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "STAPLES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "COM",
        "authorized_official_telephone_number": "843-902-7582",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maverick Medical Transport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marion Regional Healthcare System (Marion County Orthopaedics)
• Marion Regional Healthcare System (Advanced Medical Associates)
• Marion SC Emergency Physicians
• Marion School District Seven
• Gangatharan Mathisuthan, M.D
• Julianna Maynor, NURSE PRACTITIONER
• McLeod Health Cheraw (McLeod Family Medicine-Marion)
• McLeod Physician Associates II (McLeod Family Medicine - Marion County)
• McLeod Physician Associates, Inc (McLeod Family Medicine - Marion County)
• Tammy B McMillan

• Land Ambulance in Mullins, SC
• Providers in Mullins, SC by specialty
• Land Ambulance in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.