Healthcare Provider Details

I. General information

NPI: 1093324337
Provider Name (Legal Business Name): RELIABLE MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH ST
CHATTANOOGA TN
37404-5319
US

IV. Provider business mailing address

PO BOX 3118
CHATTANOOGA TN
37404-0118
US

V. Phone/Fax

Practice location:
  • Phone: 423-888-1250
  • Fax: 423-497-5718
Mailing address:
  • Phone: 423-888-1250
  • Fax: 423-497-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: BRESHALIA M JACKSON
Title or Position: OWNER/MANGER
Credential:
Phone: 423-888-1250