MEDICARE: CAUGHRON TRANSPORT SERVICE 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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1770369357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAUGHRON TRANSPORT SERVICE LLC

Provider Business Mailing Address
First Line	:	6527 CANNON RD
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-1429
Country	:	US
Telephone Number	:	888-233-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	6527 CANNON RD
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-1429
Country	:	US
Telephone Number	:	888-233-4760
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES DELANO CAUGHRON II
Credential	:
Telephone Number	:	888-233-4760

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	05/13/2026

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