Provider Demographics
NPI:1659350809
Name:PROFESSIONAL MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL TRANSPORT
Other - Org Name:'PROMED EMS'
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENDERLIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-938-2273
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-1509
Mailing Address - Country:US
Mailing Address - Phone:865-689-5262
Mailing Address - Fax:865-689-5354
Practice Address - Street 1:1335 CALLAHAN DR.
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1204
Practice Address - Country:US
Practice Address - Phone:865-938-2273
Practice Address - Fax:865-938-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000100203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574612Medicaid
TN3574612Medicaid