Provider Demographics
NPI:1861252256
Name:BOONE, TAMETROUS
Entity type:Individual
Prefix:MR
First Name:TAMETROUS
Middle Name:
Last Name:BOONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SUMMIT AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7813
Mailing Address - Country:US
Mailing Address - Phone:336-402-4553
Mailing Address - Fax:336-464-2932
Practice Address - Street 1:801 SUMMIT AVE STE 2A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7813
Practice Address - Country:US
Practice Address - Phone:336-402-4553
Practice Address - Fax:336-464-2932
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)