Healthcare Provider Details

I. General information

NPI: 1922371640
Provider Name (Legal Business Name): MOUNTAIN TRANSPORTATION;L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 THE FOREST RD
BLUE RIDGE GA
30513-9219
US

IV. Provider business mailing address

19 THE FOREST ROAD
BLUE RIDGE GA
30513
US

V. Phone/Fax

Practice location:
  • Phone: 706-851-9465
  • Fax: 706-632-5377
Mailing address:
  • Phone: 706-851-9465
  • Fax: 706-632-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateGA

VIII. Authorized Official

Name: MISS ESTELLE HILFSTEIN
Title or Position: OWNER/MGR
Credential:
Phone: 706-851-9465