Provider Demographics
NPI:1750414025
Name:TRI-CITIES TRANSPORTATION
Entity type:Organization
Organization Name:TRI-CITIES TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-791-4658
Mailing Address - Street 1:804 HILLMOOR DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2106
Mailing Address - Country:US
Mailing Address - Phone:423-791-4658
Mailing Address - Fax:423-926-0362
Practice Address - Street 1:804 HILLMOOR DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2106
Practice Address - Country:US
Practice Address - Phone:423-791-4658
Practice Address - Fax:423-926-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000157Medicaid
TN100043616OtherPHP
TN4065730OtherBLUECARE