Provider Demographics
NPI:1710353636
Name:TRADEMARK MEDICAL TRANSPORT OF COMMERCE, INC
Entity Type:Organization
Organization Name:TRADEMARK MEDICAL TRANSPORT OF COMMERCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ELROY
Authorized Official - Last Name:EASON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:706-521-4421
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0034
Mailing Address - Country:US
Mailing Address - Phone:706-521-4421
Mailing Address - Fax:
Practice Address - Street 1:32 PINE ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2712
Practice Address - Country:US
Practice Address - Phone:706-658-6964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078-53416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport