Provider Demographics
NPI:1881469310
Name:ULTIMATE EXPERIENCE
Entity type:Organization
Organization Name:ULTIMATE EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:LESHEA
Authorized Official - Last Name:STALLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-320-6767
Mailing Address - Street 1:1463 MARKET ST STE 105B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-4465
Mailing Address - Country:US
Mailing Address - Phone:423-320-6767
Mailing Address - Fax:
Practice Address - Street 1:1463 MARKET ST STE 105B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-4465
Practice Address - Country:US
Practice Address - Phone:423-320-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)