Provider Demographics
NPI:1912384801
Name:COVENANT MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:COVENANT MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-530-0993
Mailing Address - Street 1:6759 BAUXHALL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-0629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-421-8586
Practice Address - Street 1:6759 BAUXHALL DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-0629
Practice Address - Country:US
Practice Address - Phone:901-530-0993
Practice Address - Fax:901-421-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance