Healthcare Provider Details

I. General information

NPI: 1104712710
Provider Name (Legal Business Name): ON TIME TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MISSY DR
STATE LINE MS
39362-7923
US

IV. Provider business mailing address

132 MISSY DR
STATE LINE MS
39362-7923
US

V. Phone/Fax

Practice location:
  • Phone: 601-818-9535
  • Fax:
Mailing address:
  • Phone: 601-818-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. TRAYVON ANTONIO HOUSTON
Title or Position: CEO
Credential: CEO
Phone: 601-818-9535