Provider Demographics
NPI:1215596713
Name:EMMANUEL TRANSIT, LLC
Entity type:Organization
Organization Name:EMMANUEL TRANSIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:SR
Authorized Official - Credentials:M DIV
Authorized Official - Phone:228-249-0466
Mailing Address - Street 1:4337 TERRACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563
Mailing Address - Country:US
Mailing Address - Phone:228-372-4464
Mailing Address - Fax:
Practice Address - Street 1:4337 TERRACE DRIVE
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563
Practice Address - Country:US
Practice Address - Phone:228-372-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMANUEL TRANSIT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)