=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083426621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLINS CONNECT TRANSPORT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2025
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1664 GAP CREEK RD
-----------------------------------------------------
City | LYMAN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29365-9326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-214-4990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1664 GAP CREEK RD
-----------------------------------------------------
City | LYMAN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29365-9326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-214-4990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. ALEEYA B PARKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-823-6039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------