=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922371640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN TRANSPORTATION;L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2012
-----------------------------------------------------
Last Update Date | 02/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 THE FOREST RD
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-9219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-851-9465
-----------------------------------------------------
Fax | 706-632-5377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 THE FOREST ROAD
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-851-9465
-----------------------------------------------------
Fax | 706-632-5377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MGR
-----------------------------------------------------
Name | MISS ESTELLE HILFSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-851-9465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------