Healthcare Provider Details

I. General information

NPI: 1548091424
Provider Name (Legal Business Name): PREMIER RELIABLE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W LONG 17TH ST
NORTH LITTLE ROCK AR
72114-3230
US

IV. Provider business mailing address

1400 W LONG 17TH ST
NORTH LITTLE ROCK AR
72114-3230
US

V. Phone/Fax

Practice location:
  • Phone: 501-346-8010
  • Fax:
Mailing address:
  • Phone: 501-346-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DARREN HUMPHREY JR.
Title or Position: OWNER/MANAGER
Credential:
Phone: 501-346-8010