Provider Demographics
NPI:1164986410
Name:WADE, TASHA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 BAIRD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7302
Mailing Address - Country:US
Mailing Address - Phone:901-860-3230
Mailing Address - Fax:
Practice Address - Street 1:606 HURON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-1405
Practice Address - Country:US
Practice Address - Phone:901-860-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No171WV0202XOther Service ProvidersContractorVehicle Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN833104295OtherNEMT
TN833104295OtherNON MEDICAL EMERGENCY TRANSPORTATION
TN833104295OtherNON MEDICAL TRANSPORTATION