Provider Demographics
NPI:1700943651
Name:DIANE'S MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:DIANE'S MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-358-0020
Mailing Address - Street 1:1015 WEBSTER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-5497
Mailing Address - Country:US
Mailing Address - Phone:423-358-0020
Mailing Address - Fax:423-272-8519
Practice Address - Street 1:1015 WEBSTER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-5497
Practice Address - Country:US
Practice Address - Phone:423-358-0020
Practice Address - Fax:423-272-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000137Medicaid