Provider Demographics
NPI:1902363468
Name:CTC TRANSPORTATION LLC
Entity Type:Organization
Organization Name:CTC TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-509-8272
Mailing Address - Street 1:6099 MOUNT MORIAH ROAD EXT STE 9A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0311
Mailing Address - Country:US
Mailing Address - Phone:901-509-8272
Mailing Address - Fax:901-410-4545
Practice Address - Street 1:6099 MOUNT MORIAH ROAD EXT STE 9A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0311
Practice Address - Country:US
Practice Address - Phone:901-509-8272
Practice Address - Fax:901-410-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048164Medicaid