Provider Demographics
NPI:1033469598
Name:TRANSPORT AMERICA AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:TRANSPORT AMERICA AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-805-2006
Mailing Address - Street 1:PO BOX 1872
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-1872
Mailing Address - Country:US
Mailing Address - Phone:912-805-2006
Mailing Address - Fax:912-805-2004
Practice Address - Street 1:603 BROGDON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-6031
Practice Address - Country:US
Practice Address - Phone:902-805-2007
Practice Address - Fax:912-805-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport