Provider Demographics
NPI:1093251845
Name:RELIANT MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:RELIANT MEDICAL TRANSPORTATION, LLC
Other - Org Name:RELIANT MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W (TRIPP)
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-573-0075
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:13 NORTHTOWN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3047
Practice Address - Country:US
Practice Address - Phone:601-487-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ062772Medicaid
MS06972772Medicaid
MS710025000OtherDOL