1538143110 NPI number — MED-TRANS OF TENNESSEE INC

Table of content: (NPI 1538143110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538143110 NPI number — MED-TRANS OF TENNESSEE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED-TRANS OF TENNESSEE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538143110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 854
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-745-0467
Provider Business Mailing Address Fax Number:
423-744-3500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 DAVIDSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-745-3132
Provider Business Practice Location Address Fax Number:
423-745-4673
Provider Enumeration Date:
12/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
423-745-3132

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  5404 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590006495 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00B72671A . This is a "GA MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3560811 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".