Provider Demographics
NPI:1710566344
Name:REGAL HEALTH TRANSPORTATION LLC
Entity Type:Organization
Organization Name:REGAL HEALTH TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-497-1096
Mailing Address - Street 1:1109 S GRAYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4427
Mailing Address - Country:US
Mailing Address - Phone:615-497-1096
Mailing Address - Fax:
Practice Address - Street 1:1109 S GRAYCROFT AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4427
Practice Address - Country:US
Practice Address - Phone:615-497-1096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)