Provider Demographics
NPI:1154809820
Name:COOPERS TRANSPORT LLC
Entity type:Organization
Organization Name:COOPERS TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:MCINNIS
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-639-0358
Mailing Address - Street 1:2016 SUNSET MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6359
Mailing Address - Country:US
Mailing Address - Phone:757-639-0358
Mailing Address - Fax:757-299-1126
Practice Address - Street 1:2016 SUNSET MAPLE LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-6359
Practice Address - Country:US
Practice Address - Phone:757-639-0358
Practice Address - Fax:757-299-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAN12-899343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)