Provider Demographics
NPI:1912074030
Name:MEDIC TRANSPORTATION, LLC.
Entity Type:Organization
Organization Name:MEDIC TRANSPORTATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-550-1940
Mailing Address - Street 1:3180 MILLINGTON RD.
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127
Mailing Address - Country:US
Mailing Address - Phone:901-362-4171
Mailing Address - Fax:901-362-4172
Practice Address - Street 1:3180 MILLINGTON RD.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127
Practice Address - Country:US
Practice Address - Phone:901-362-4171
Practice Address - Fax:901-362-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000215Medicaid
TNT000197Medicaid