Organization
B2B MED-TRANS
Active
Organization
B2B MED-TRANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BINIAM SEREKE HABTE (CEO)
(615) 707-5828
Entity
Organization
Contact information
Practice address
108 MARY JOE MARTIN DR, LA VERGNE, TN 37086-5264
(615) 707-5828
Mailing address
108 MARY JOE MARTIN DR, LA VERGNE, TN 37086-5264
(615) 707-5828
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-1889072
TENNCARE
TN
05
—
81-1889072
—
TN
Enumeration date
03/22/2016
Last updated
03/22/2016
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