Provider Demographics
NPI:1346542032
Name:MISS IDA TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MISS IDA TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-244-6026
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:GA
Mailing Address - Zip Code:31051-0104
Mailing Address - Country:US
Mailing Address - Phone:478-244-6026
Mailing Address - Fax:206-424-0513
Practice Address - Street 1:721 JALAPPA
Practice Address - Street 2:
Practice Address - City:BYROMVILLE
Practice Address - State:GA
Practice Address - Zip Code:31007
Practice Address - Country:US
Practice Address - Phone:478-244-6026
Practice Address - Fax:206-424-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)