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General NPI Number Information
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NPI Number | 1649446212
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Entity Type | Organization
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Legal Business Name | CHEYENNE'S TOTAL CARE/TRANSPORATION
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 122 W COMMERCE ST
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City | ABERDEEN
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State | MS
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Zip | 39730
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Country | US
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Telephone | 662-369-0430
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Fax | 662-369-0439
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Provider Business Mailing Address
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Address Line | PO BOX 88
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City | PRARIE
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State | MS
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Zip | 39756
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Country | US
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Telephone | 662-369-0430
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Fax | 662-369-0439
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. PATRICIA ANN CLAY
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Credential |
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Telephone | 662-369-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 3780
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License Number State | MS
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