Provider Demographics
NPI:1275298960
Name:THE PETTIS GROUP, LLC
Entity Type:Organization
Organization Name:THE PETTIS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-495-1776
Mailing Address - Street 1:2942 N 24TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7849
Mailing Address - Country:US
Mailing Address - Phone:602-960-4886
Mailing Address - Fax:602-960-4876
Practice Address - Street 1:3119 W COCHISE DR
Practice Address - Street 2:UNIT 154
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:602-960-4886
Practice Address - Fax:602-960-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)