Provider Demographics
NPI:1275097206
Name:SOUTHERN TRANS LLC
Entity Type:Organization
Organization Name:SOUTHERN TRANS LLC
Other - Org Name:SOUTHERN TRANS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-932-0300
Mailing Address - Street 1:100 WAVERLEY DR APT L1
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5290
Mailing Address - Country:US
Mailing Address - Phone:540-932-0300
Mailing Address - Fax:509-561-3599
Practice Address - Street 1:100 WAVERLEY DR APT L1
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-5290
Practice Address - Country:US
Practice Address - Phone:540-388-3337
Practice Address - Fax:540-932-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)