Provider Demographics
NPI:1124658349
Name:TRAVERSE TRANSPORT L.L.C.
Entity type:Organization
Organization Name:TRAVERSE TRANSPORT L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DION
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-595-8832
Mailing Address - Street 1:1402 LANTERN LIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8733
Mailing Address - Country:US
Mailing Address - Phone:646-595-8832
Mailing Address - Fax:
Practice Address - Street 1:1402 LANTERN LIGHT TRL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8733
Practice Address - Country:US
Practice Address - Phone:646-595-8832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)