Organization
PROSPERITY TRANS 1 LLC
Active
Parent organization
PROSPERITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROSPERITY
Authorized official
PRIEST M AVANT (OWNEROPERATOR)
(901) 833-3656
Entity
Organization
Contact information
Practice address
156 STAR BLOSSOM DR APT 408, 2600 POPLAR AVE 120, MEMPHIS, TN 38103-1650
(901) 833-3656
(901) 207-6204
Mailing address
2600 POPLAR AVE STE 120, MEMPHIS, TN 38112-3835
(901) 207-6015
(901) 207-6204
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
076902577
TN
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q017230
—
TN
Enumeration date
02/23/2016
Last updated
05/24/2016
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