Provider Demographics
NPI:1508696576
Name:NETTRANS
Entity type:Organization
Organization Name:NETTRANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STREETMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:864-372-6664
Mailing Address - Street 1:8305 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4532
Mailing Address - Country:US
Mailing Address - Phone:864-372-6664
Mailing Address - Fax:
Practice Address - Street 1:8305 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4532
Practice Address - Country:US
Practice Address - Phone:864-372-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1762536OtherSOUTH CAROLINA, RN LICENSE: