Provider Demographics
NPI:1831956085
Name:AG TRANSPORTATION
Entity type:Organization
Organization Name:AG TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:ASSEFA
Authorized Official - Last Name:ABEBE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:469-334-1741
Mailing Address - Street 1:4801 SANDYROCK LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3860
Mailing Address - Country:US
Mailing Address - Phone:469-334-1741
Mailing Address - Fax:
Practice Address - Street 1:4801 SANDYROCK LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3860
Practice Address - Country:US
Practice Address - Phone:469-334-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)