Provider Demographics
NPI:1073341764
Name:BLACK & RED TRANSPORTATION
Entity type:Organization
Organization Name:BLACK & RED TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KETAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:419-467-9806
Mailing Address - Street 1:2340 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3527
Mailing Address - Country:US
Mailing Address - Phone:419-467-9806
Mailing Address - Fax:
Practice Address - Street 1:2340 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3527
Practice Address - Country:US
Practice Address - Phone:419-467-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)