Provider Demographics
NPI:1891330007
Name:EMINENCE TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:EMINENCE TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAMIKA
Authorized Official - Middle Name:SHANTELL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-652-6102
Mailing Address - Street 1:3421 SELLERS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-5230
Mailing Address - Country:US
Mailing Address - Phone:901-652-6102
Mailing Address - Fax:
Practice Address - Street 1:3421 SELLERS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5230
Practice Address - Country:US
Practice Address - Phone:901-652-6102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)