Healthcare Provider Details

I. General information

NPI: 1730365685
Provider Name (Legal Business Name): IMMEDIATE RESPONSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 DEERWOOD AVE
MEMPHIS TN
38111-5410
US

IV. Provider business mailing address

3544 DEERWOOD AVE
MEMPHIS TN
38111-5410
US

V. Phone/Fax

Practice location:
  • Phone: 901-212-9001
  • Fax: 901-757-1146
Mailing address:
  • Phone: 901-212-9001
  • Fax: 901-757-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIA OWENS
Title or Position: OWNER/MANAGER
Credential:
Phone: 901-212-9001