Provider Demographics
NPI:1174067144
Name:INFINITE SUPPORT MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:INFINITE SUPPORT MEDICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:678-458-5935
Mailing Address - Street 1:155 WESTRIDGE PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3049
Mailing Address - Country:US
Mailing Address - Phone:678-782-3024
Mailing Address - Fax:
Practice Address - Street 1:155 WESTRIDGE PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:678-782-3024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-11
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMB20170013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport