MEDICARE: EAGLEYE PROFESSIONAL NEMT TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1417794298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLEYE PROFESSIONAL NEMT TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	605 DEAN RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-8857
Country	:	US
Telephone Number	:	901-650-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 DEAN RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-8857
Country	:	US
Telephone Number	:	901-650-5705
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEVEN FORD KEESEE
Credential	:
Telephone Number	:	901-650-5705

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	06/09/2026

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