Luke Medical Transport LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

LUKE MEDICAL TRANSPORT LLC

Practice address

260 International Pkwy Ste 132
Dallas, GA 30157-5706

Phone

(765) 265-5361

Fax

(678) 567-7922

NPI assigned

Oct 4, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Vance Andre Raham, MDNPI 1881667046

Title

Partner

Phone

(765) 265-5361

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vance Andre' Raham, M.D.

  • Addiction Medicine (Family Medicine) Physician
  • Marietta, GA
  • NPI 1881667046
  NPD Authorized official

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1295376838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 MIMMS CT NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300646227",
            "telephone_number": "765-265-5361",
            "fax_number": "678-567-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 INTERNATIONAL PKWY STE 132",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575706",
            "telephone_number": "765-265-5361",
            "fax_number": "678-567-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUKE MEDICAL TRANSPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-04",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "RAHAM",
        "authorized_official_first_name": "VANCE",
        "authorized_official_middle_name": "ANDRE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "765-265-5361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "None",
            "affiliation": "N",
            "address_1": "260 International Pkwy Ste 132",
            "city": "Dallas",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301575706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Land Ambulance in Dallas, GA
• Providers in Dallas, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; 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.