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General NPI Number Information
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NPI Number | 1033469598
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Entity Type | Organization
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Legal Business Name | TRANSPORT AMERICA AMBULANCE SERVICE LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 603 BROGDON ST
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City | VIDALIA
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State | GA
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Zip | 30474-6031
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Country | US
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Telephone | 902-805-2007
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Fax | 912-805-2004
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Provider Business Mailing Address
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Address Line | PO BOX 1872
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City | VIDALIA
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State | GA
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Zip | 30475-1872
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Country | US
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Telephone | 912-805-2006
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Fax | 912-805-2004
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Authorized Official
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Title or Position | CFO
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Name | MRS. LISA DARLENE FLANAGAN
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Credential | DO
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Telephone | 912-805-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 076-02
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License Number State | GA
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