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General NPI Number Information
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NPI Number | 1861956617
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Entity Type | Organization
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Legal Business Name | TRISTATE TRANSPORTATION GROUP, LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 4719 BRAINERD RD STE 125
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3840
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Country | US
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Telephone | 423-355-3021
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Fax |
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Provider Business Mailing Address
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Address Line | 506 BLUE JAY RD
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City | CHATTANOOGA
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State | TN
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Zip | 37412-4108
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Country | US
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Telephone | 423-355-3021
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | KENNETH LEBRON SIMPSON
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Credential |
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Telephone | 423-355-3021
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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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