Healthcare Provider Details

I. General information

NPI: 1548777923
Provider Name (Legal Business Name): NEMTRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2018
Last Update Date: 01/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 AUSTIN DR
OAKLAND TN
38060-4088
US

IV. Provider business mailing address

120 AUSTIN DR
OAKLAND TN
38060-4088
US

V. Phone/Fax

Practice location:
  • Phone: 901-644-4793
  • Fax:
Mailing address:
  • Phone: 901-644-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENALDO TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 901-644-4793