Provider Demographics
NPI:1568123800
Name:SPEARS, PATRICK L
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:SPEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14029 KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8492
Mailing Address - Country:US
Mailing Address - Phone:901-828-1769
Mailing Address - Fax:
Practice Address - Street 1:14029 KNIGHTSBRIDGE LN
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8492
Practice Address - Country:US
Practice Address - Phone:901-828-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)