=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639868797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CARRIER SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2023
-----------------------------------------------------
Last Update Date | 05/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10310 W MARKHAM ST STE 193
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-366-9779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5918 DREXEL AVE
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-8418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-366-9779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | VERONICA G LOVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-366-9779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------