Provider Demographics
NPI:1295159861
Name:GARNER, RANDY MONTRALL (OWNER)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:MONTRALL
Last Name:GARNER
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1234
Mailing Address - Street 2:
Mailing Address - City:HUTCHINS
Mailing Address - State:TX
Mailing Address - Zip Code:75141
Mailing Address - Country:US
Mailing Address - Phone:214-454-1279
Mailing Address - Fax:972-803-4720
Practice Address - Street 1:301 FIRST ST. # 229
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:TX
Practice Address - Zip Code:75172
Practice Address - Country:US
Practice Address - Phone:214-454-1279
Practice Address - Fax:972-803-4720
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09155266343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)