Provider Demographics
NPI:1538751607
Name:SOUTH BOSTON TRANSPORTATION LLC
Entity type:Organization
Organization Name:SOUTH BOSTON TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYPHAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-444-2334
Mailing Address - Street 1:1215 OLD GRUBBY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-6139
Mailing Address - Country:US
Mailing Address - Phone:240-444-2334
Mailing Address - Fax:
Practice Address - Street 1:1215 OLD GRUBBY RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-6139
Practice Address - Country:US
Practice Address - Phone:240-444-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No347C00000XTransportation ServicesPrivate Vehicle