Healthcare Provider Details

I. General information

NPI: 1326681594
Provider Name (Legal Business Name): CHC901 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 HORIZON LAKE DR STE 110
MEMPHIS TN
38133-8113
US

IV. Provider business mailing address

PO BOX 250
BRUNSWICK TN
38014-0250
US

V. Phone/Fax

Practice location:
  • Phone: 901-321-0911
  • Fax:
Mailing address:
  • Phone: 901-425-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL W NOLEN JR.
Title or Position: CHAIRMAN
Credential:
Phone: 901-275-5131