Provider Demographics
NPI:1588136378
Name:VAUGHSERENITY TRANSPORT
Entity type:Organization
Organization Name:VAUGHSERENITY TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-767-2417
Mailing Address - Street 1:2 N JACKSON ST STE 605B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3821
Mailing Address - Country:US
Mailing Address - Phone:469-767-2417
Mailing Address - Fax:
Practice Address - Street 1:2 N JACKSON ST STE 605B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-3821
Practice Address - Country:US
Practice Address - Phone:469-767-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)