Healthcare Provider Details

I. General information

NPI: 1902363468
Provider Name (Legal Business Name): CTC TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6099 MOUNT MORIAH ROAD EXT STE 9A
MEMPHIS TN
38115-0311
US

IV. Provider business mailing address

6099 MOUNT MORIAH ROAD EXT STE 9A
MEMPHIS TN
38115-0311
US

V. Phone/Fax

Practice location:
  • Phone: 901-509-8272
  • Fax: 901-410-4545
Mailing address:
  • Phone: 901-509-8272
  • Fax: 901-410-4545

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: ADRIANE RENEE HARRIS
Title or Position: OWNER
Credential:
Phone: 901-509-8272