Provider Demographics
NPI:1982069464
Name:SARRAH MEDICAL TRANS
Entity Type:Organization
Organization Name:SARRAH MEDICAL TRANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SARRAH
Authorized Official - Middle Name:ELNOUR
Authorized Official - Last Name:WIDATALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-717-4174
Mailing Address - Street 1:944 21ST AVE N
Mailing Address - Street 2:APT 802
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3400
Mailing Address - Country:US
Mailing Address - Phone:615-717-4174
Mailing Address - Fax:
Practice Address - Street 1:422 MILLWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1605
Practice Address - Country:US
Practice Address - Phone:615-717-4174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN190538343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)