Provider Demographics
NPI:1972018505
Name:MEDTRANS OF TN , LLC
Entity Type:Organization
Organization Name:MEDTRANS OF TN , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVONERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-495-2323
Mailing Address - Street 1:1331 UNION AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3513
Mailing Address - Country:US
Mailing Address - Phone:901-495-2323
Mailing Address - Fax:
Practice Address - Street 1:1331 UNION AVE STE 1000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3513
Practice Address - Country:US
Practice Address - Phone:855-633-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X, 347E00000X, 343900000X, 347E00000X
MS343900000X, 347E00000X, 343900000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)