Transport America Ambulance Service LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

076-02 Issued in GA

Legal business name

TRANSPORT AMERICA AMBULANCE SERVICE LLC

Practice address

603 Brogdon St
Vidalia, GA 30474-6031

Phone

(902) 805-2007

Fax

(912) 805-2004

NPI assigned

Sep 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Darlene Flanagan, DO

Title

Cfo

Phone

(912) 805-2006

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1033469598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1872",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304751872",
            "telephone_number": "912-805-2006",
            "fax_number": "912-805-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 BROGDON ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304746031",
            "telephone_number": "902-805-2007",
            "fax_number": "912-805-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSPORT AMERICA AMBULANCE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "FLANAGAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-805-2006",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "076-02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.