MEDICARE: NANA POP-INS MEDICAL TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1194170704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANA POP-INS MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 4702
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37831
Country	:	US
Telephone Number	:	865-964-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 S ILLINOIS AVE STE 214
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-6220
Country	:	US
Telephone Number	:	865-964-2233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBBIE LYNN WALTERS
Credential	:
Telephone Number	:	865-964-2233

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	03/11/2019

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