Healthcare Provider Details

I. General information

NPI: 1134376171
Provider Name (Legal Business Name): PRECIOUS METALS L.LC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 MUTTON HOLLOW RD
KODAK TN
37764-1689
US

IV. Provider business mailing address

PO BOX 1121
KODAK TN
37764-7121
US

V. Phone/Fax

Practice location:
  • Phone: 865-397-5466
  • Fax: 865-484-0565
Mailing address:
  • Phone: 865-397-5466
  • Fax: 865-484-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberUSDOT 1769419
License Number StateTN

VIII. Authorized Official

Name: MRS. JAMIE LIN STOREY
Title or Position: PRESIDENT
Credential:
Phone: 865-385-5277