Provider Demographics
NPI:1467209494
Name:BRADFORD FAMILY NEMT LLC
Entity type:Organization
Organization Name:BRADFORD FAMILY NEMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-278-8814
Mailing Address - Street 1:17812 BATESVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-1714
Mailing Address - Country:US
Mailing Address - Phone:870-278-8814
Mailing Address - Fax:
Practice Address - Street 1:17812 BATESVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-1714
Practice Address - Country:US
Practice Address - Phone:870-278-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)