1497208433 NPI number — TOWERINGROCK NON-EMERGENCY MEDICAL TRANSPORT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497208433 NPI number — TOWERINGROCK NON-EMERGENCY MEDICAL TRANSPORT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWERINGROCK NON-EMERGENCY MEDICAL TRANSPORT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497208433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1615
Provider Second Line Business Mailing Address:
1029 NORTH EAST SIDE TRAILER
Provider Business Mailing Address City Name:
TUBA CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-868-4629
Provider Business Mailing Address Fax Number:
928-484-2075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1029 E. TC NORTH SIDE TRAILER
Provider Second Line Business Practice Location Address:
36.153821-111.233925
Provider Business Practice Location Address City Name:
TUBA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-868-4629
Provider Business Practice Location Address Fax Number:
928-484-2075
Provider Enumeration Date:
07/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BYJOE
Authorized Official First Name:
CARMELITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
480-868-4629

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  20813806 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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