Provider Demographics
NPI:1972717627
Name:MOODY'S TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:MOODY'S TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-879-7419
Mailing Address - Street 1:1875 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504-5072
Mailing Address - Country:US
Mailing Address - Phone:931-879-7419
Mailing Address - Fax:931-879-2049
Practice Address - Street 1:1305 ROY OWENS RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-2411
Practice Address - Country:US
Practice Address - Phone:931-879-7419
Practice Address - Fax:931-879-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000142Medicaid
TN003130416OtherBLUECARE PROVIDER #