Healthcare Provider Details

I. General information

NPI: 1629207527
Provider Name (Legal Business Name): DAVCO MEDICAL TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6952 STOUT RD
MEMPHIS TN
38119-8525
US

IV. Provider business mailing address

PO BOX 382992
GERMANTOWN TN
38183-2992
US

V. Phone/Fax

Practice location:
  • Phone: 901-690-8999
  • Fax: 901-328-5677
Mailing address:
  • Phone: 901-690-8999
  • Fax: 901-328-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number74097537
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number74097537
License Number StateTN

VIII. Authorized Official

Name: CONTESIA DAVIDSON
Title or Position: PRESIDENT
Credential:
Phone: 901-690-8999