Healthcare Provider Details

I. General information

NPI: 1891355509
Provider Name (Legal Business Name): HIDDEN OAKS TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 NORTH BOOSE STREET
HICKORY MS
39332
US

IV. Provider business mailing address

P.O. BOX 166
HICKORY MS
39332
US

V. Phone/Fax

Practice location:
  • Phone: 601-745-0851
  • Fax: 601-646-5716
Mailing address:
  • Phone: 601-745-0851
  • Fax: 601-646-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY LATRICE FIELDER
Title or Position: OWNER/MANAGER
Credential:
Phone: 601-745-0851