Provider Demographics
NPI:1760035950
Name:TRIPLE-D TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:TRIPLE-D TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PARTNER
Authorized Official - Phone:901-672-3296
Mailing Address - Street 1:1660 RAYBRAD DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6038
Mailing Address - Country:US
Mailing Address - Phone:901-249-7392
Mailing Address - Fax:901-310-4896
Practice Address - Street 1:2000 ABBOTT CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3526
Practice Address - Country:US
Practice Address - Phone:901-249-7392
Practice Address - Fax:901-310-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ047871Medicaid