Provider Demographics
NPI:1629346168
Name:RELIABLE TRANSPORTATION OF TENNESSEE
Entity Type:Organization
Organization Name:RELIABLE TRANSPORTATION OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-239-2112
Mailing Address - Street 1:9659 GRAYS LAKE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7770
Mailing Address - Country:US
Mailing Address - Phone:931-239-2112
Mailing Address - Fax:
Practice Address - Street 1:9659 GRAYS LAKE CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7770
Practice Address - Country:US
Practice Address - Phone:931-239-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000141Medicaid