Provider Demographics
NPI:1902361314
Name:SLAUGHTER, RC
Entity Type:Individual
Prefix:
First Name:RC
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-9393
Mailing Address - Country:US
Mailing Address - Phone:662-497-2209
Mailing Address - Fax:662-570-1517
Practice Address - Street 1:29 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-9393
Practice Address - Country:US
Practice Address - Phone:662-497-2209
Practice Address - Fax:662-570-1517
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS802084025343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)