Provider Demographics
NPI:1386174829
Name:TRIPLE D MEDICAL TRANSPORTATION, LLC.
Entity type:Organization
Organization Name:TRIPLE D MEDICAL TRANSPORTATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:BELVERSTONE
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:636-447-7474
Mailing Address - Street 1:2451 EXECUTIVE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5606
Mailing Address - Country:US
Mailing Address - Phone:1636-447-7474
Mailing Address - Fax:636-447-7432
Practice Address - Street 1:2123 MENAUL BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-881-7433
Practice Address - Fax:505-888-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54047343800000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)