Healthcare Provider Details

I. General information

NPI: 1770290777
Provider Name (Legal Business Name): MEMPHIS MEDICAL TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 FAR DR
CORDOVA TN
38016-1673
US

IV. Provider business mailing address

1626 FAR DR
CORDOVA TN
38016-1673
US

V. Phone/Fax

Practice location:
  • Phone: 901-652-1731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: OSMAN UDETALLAH
Title or Position: INCORPORATOR
Credential:
Phone: 901-652-1731