Healthcare Provider Details

I. General information

NPI: 1235981994
Provider Name (Legal Business Name): BRUVVERS TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIDDLEWELLS COMMUNITY #52
SANDERS AZ
86512
US

IV. Provider business mailing address

413 SAGUARO DR
GALLUP NM
87301-6778
US

V. Phone/Fax

Practice location:
  • Phone: 505-457-6186
  • Fax:
Mailing address:
  • Phone: 505-457-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON SCOTT WILLIE
Title or Position: MEMBER/OWNER
Credential:
Phone: 505-457-6186