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General NPI Number Information
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NPI Number | 1811356546
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Entity Type | Organization
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Legal Business Name | PROSPERITY TRANS 1 LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 156 STAR BLOSSOM DR APT 408 2600 POPLAR AVE 120
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City | MEMPHIS
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State | TN
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Zip | 38103-1650
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Country | US
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Telephone | 901-833-3656
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Fax | 901-207-6204
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Provider Business Mailing Address
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Address Line | 2600 POPLAR AVE STE 120
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City | MEMPHIS
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State | TN
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Zip | 38112-3835
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Country | US
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Telephone | 901-207-6015
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Fax | 901-207-6204
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Authorized Official
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Title or Position | OWNEROPERATOR
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Name | PRIEST M AVANT
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Credential |
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Telephone | 901-833-3656
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 076902577
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License Number State | TN
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