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General NPI Number Information
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NPI Number | 1659350809
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL TRANSPORT
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Dates
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Enumeration Date | 01/14/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1335 CALLAHAN DR.
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City | KNOXVILLE
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State | TN
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Zip | 37912-1204
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Country | US
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Telephone | 865-938-2273
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Fax | 865-938-1638
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Provider Business Mailing Address
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Address Line | PO BOX 1509
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City | NORRIS
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State | TN
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Zip | 37828-1509
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Country | US
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Telephone | 865-689-5262
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Fax | 865-689-5354
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Authorized Official
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Title or Position | CEO
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Name | DANNY LYNN HENDERLIGHT
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Credential |
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Telephone | 865-938-2273
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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 | EMS0000010020
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License Number State | TN
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