Provider Demographics
NPI:1881477149
Name:SOUTHERN GRYLS MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:SOUTHERN GRYLS MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERMON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:248-412-3319
Mailing Address - Street 1:3728 SUGARBARK DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7712
Mailing Address - Country:US
Mailing Address - Phone:248-412-3319
Mailing Address - Fax:
Practice Address - Street 1:3728 SUGARBARK DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7712
Practice Address - Country:US
Practice Address - Phone:248-412-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle