Healthcare Provider Details

I. General information

NPI: 1649895004
Provider Name (Legal Business Name): PTI TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 STAGE RD STE 204
MEMPHIS TN
38128-5762
US

IV. Provider business mailing address

3419 TYRON CV
BARTLETT TN
38135-2501
US

V. Phone/Fax

Practice location:
  • Phone: 901-585-0952
  • Fax:
Mailing address:
  • Phone: 901-691-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARILYN DEMETRICA COLEMAN
Title or Position: CEO
Credential:
Phone: 901-691-8574