Healthcare Provider Details

I. General information

NPI: 1104279397
Provider Name (Legal Business Name): DRIVE-A-PAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 POPLAR AVE STE 301
MEMPHIS TN
38111-4684
US

IV. Provider business mailing address

3340 POPLAR AVE STE 301
MEMPHIS TN
38111-4684
US

V. Phone/Fax

Practice location:
  • Phone: 901-410-2155
  • Fax:
Mailing address:
  • Phone: 901-410-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number160000409
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number160000409
License Number StateTN

VIII. Authorized Official

Name: MR. RICKEY HORTON
Title or Position: CEO
Credential:
Phone: 901-653-8082