Provider Demographics
NPI:1588997050
Name:MEDTRANS TN, LLC
Entity type:Organization
Organization Name:MEDTRANS TN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE-PRESIDENT, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-487-8268
Mailing Address - Street 1:PO BOX 172232
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-2232
Mailing Address - Country:US
Mailing Address - Phone:901-487-8268
Mailing Address - Fax:662-429-1207
Practice Address - Street 1:1615 PAGE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6923
Practice Address - Country:US
Practice Address - Phone:901-487-8268
Practice Address - Fax:662-429-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)