Healthcare Provider Details

I. General information

NPI: 1851555072
Provider Name (Legal Business Name): EMMANUEL MEDICAL TRANSPORTS AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 RASCO RD SUITE 344
SOUTHAVEN MS
38671
US

IV. Provider business mailing address

3567 TUTWILER AVE
MEMPHIS TN
38122-3601
US

V. Phone/Fax

Practice location:
  • Phone: 901-592-5342
  • Fax: 901-473-9179
Mailing address:
  • Phone: 901-626-9506
  • Fax: 901-473-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY LEE PICKERING
Title or Position: CEO
Credential: PARAMEDIC
Phone: 901-626-9506