Provider Demographics
NPI:1922885961
Name:DELTA MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:DELTA MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTH OFFICIAL/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-326-9102
Mailing Address - Street 1:2481 EAGLERIDGE LN W
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8456
Mailing Address - Country:US
Mailing Address - Phone:901-326-9102
Mailing Address - Fax:
Practice Address - Street 1:2481 EAGLERIDGE LN W
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-8456
Practice Address - Country:US
Practice Address - Phone:901-326-9102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport