Dedric Marvin Mangum

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Practice address

178 Isaac TRL
Roxboro, NC 27574-9086

Phone

(336) 592-3989

NPI assigned

Jun 22, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1740859909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 ISAAC TRL",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275749086",
            "telephone_number": "336-592-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 ISAAC TRL",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275749086",
            "telephone_number": "336-592-3989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "DEDRIC",
        "middle_name": "MARVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.logisticare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Transportation scheduling app-Parascope",
            "address_1": "178 Isaac Trl",
            "city": "Roxboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275749086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas D Long Jr., MD
• Erica Eileen Luna, OTR
• Maureen Frances Lynch, AGNP-C
• Kaitlyn Kirby Lytle, PA-C
• Peter W. Majka Jr., PAC
• Shenita Paulette Mangum, LCSWA, LCASA
• Mankind LLC
• Marlab,Inc
• Crystal Lynn Martin, AGNP-BC
• Mary Rowe FCH

• Non-emergency Medical Transport (VAN) in Roxboro, NC
• Providers in Roxboro, NC by specialty
• Non-emergency Medical Transport (VAN) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.