=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598163784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. BRITE COOPER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2014
-----------------------------------------------------
Last Update Date | 12/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 BILBREY RD
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38570-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-265-7761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 BILBREY RD
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38570-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-265-7761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 033826192
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------