| Organization Name: | TRANSPORT AMERICA AMBULANCE SERVICE LLC |
| NPI Number: | 1033469598 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUSSELL KEITH BRANTLEY (DIRECTOR) |
| Mailing Address: | 534 Hwy 247 South Bonaire |
| State: | GA US |
| Postal Code: | 31005 |
| Phone Number: | 4782256111 |
| Fax Number: | 4782256232 |
| NPI Enumeration Date: | 09/12/2012 |
| NPI Last Update Date: | 09/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 076-02 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |