Healthcare Provider Details

I. General information

NPI: 1568251213
Provider Name (Legal Business Name): LETASH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9037 BILLY PAT DR
OLIVE BRANCH MS
38654-6844
US

IV. Provider business mailing address

9037 BILLY PAT DR
OLIVE BRANCH MS
38654-6844
US

V. Phone/Fax

Practice location:
  • Phone: 901-846-2272
  • Fax:
Mailing address:
  • Phone: 901-846-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LETASHA DANTZLER
Title or Position: CEO
Credential:
Phone: 901-846-2272