Healthcare Provider Details

I. General information

NPI: 1851844633
Provider Name (Legal Business Name): MED TRANSPORT MIDSOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 POPLAR AVE STE 2720
MEMPHIS TN
38137-4000
US

IV. Provider business mailing address

5100 POPLAR AVE STE 2700
MEMPHIS TN
38137-2700
US

V. Phone/Fax

Practice location:
  • Phone: 615-484-8128
  • Fax:
Mailing address:
  • Phone: 615-484-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number01107
License Number StateTN

VIII. Authorized Official

Name: BARONESE STOKES
Title or Position: OWNER
Credential:
Phone: 615-484-8128