Provider Demographics
NPI:1285462010
Name:MIYA'S REMARKABLE TRANSPORT LLC
Entity type:Organization
Organization Name:MIYA'S REMARKABLE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-289-2840
Mailing Address - Street 1:807 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-7823
Mailing Address - Country:US
Mailing Address - Phone:706-289-2840
Mailing Address - Fax:
Practice Address - Street 1:807 9TH AVE S
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-7823
Practice Address - Country:US
Practice Address - Phone:706-289-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)