Provider Demographics
NPI:1720535339
Name:BROWN, LUCRETIA ANN (NEMT)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 SESSIONS RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9744
Mailing Address - Country:US
Mailing Address - Phone:803-414-3382
Mailing Address - Fax:
Practice Address - Street 1:6938 FAUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7529
Practice Address - Country:US
Practice Address - Phone:803-414-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341600000X, 3416L0300X, 343900000X, 344600000X, 347C00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343800000XMedicaid
NC273Y00000XMedicaid
NC3416L0300XMedicaid
NC347E00000XMedicaid
NC343900000XMedicaid
GA003179665AMedicaid
NC344600000XMedicaid