Provider Demographics
NPI:1508151275
Name:PROVIDENCE EMS, LLC
Entity Type:Organization
Organization Name:PROVIDENCE EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-550-9100
Mailing Address - Street 1:5830 MOUNT MORIAH RD
Mailing Address - Street 2:SUITE 18C
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1607
Mailing Address - Country:US
Mailing Address - Phone:901-550-9100
Mailing Address - Fax:901-794-7877
Practice Address - Street 1:1283 BREEDLOVE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-1640
Practice Address - Country:US
Practice Address - Phone:901-550-9100
Practice Address - Fax:901-794-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance