Provider Demographics
NPI:1154825750
Name:PARRISH MEDI-VAN
Entity Type:Organization
Organization Name:PARRISH MEDI-VAN
Other - Org Name:PARRISH MEDI-VAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-758-3003
Mailing Address - Street 1:1101 SW TUSTENUGGEE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2164
Mailing Address - Country:US
Mailing Address - Phone:386-758-3003
Mailing Address - Fax:386-758-3064
Practice Address - Street 1:275 SW YOUNG PL
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-2181
Practice Address - Country:US
Practice Address - Phone:386-758-3003
Practice Address - Fax:386-758-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)