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General NPI Number Information
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NPI Number | 1851695001
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Entity Type | Organization
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Legal Business Name | TRADITIONAL TRANSPORT
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 9111 CROSS PARK DR SUITE D-200
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City | KNOXVILLE
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State | TN
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Zip | 37923-4506
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Country | US
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Telephone | 865-659-5005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52894
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City | KNOXVILLE
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State | TN
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Zip | 37950-2894
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Country | US
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Telephone | 865-659-5005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL DUGGER
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Credential |
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Telephone | 865-659-5005
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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 | 066481328
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License Number State | TN
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