Provider Demographics
NPI:1033974407
Name:LACY'S MEDIGO TRANSIT
Entity Type:Organization
Organization Name:LACY'S MEDIGO TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMIANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-535-5320
Mailing Address - Street 1:3044 MORRELL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4053
Mailing Address - Country:US
Mailing Address - Phone:214-535-5320
Mailing Address - Fax:
Practice Address - Street 1:3044 MORRELL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4053
Practice Address - Country:US
Practice Address - Phone:214-535-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)