Healthcare Provider Details

I. General information

NPI: 1437275310
Provider Name (Legal Business Name): DELTA TRANSPORTAION COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S STATE ST
DOVER DE
19901-4124
US

IV. Provider business mailing address

1102 S STATE ST
DOVER DE
19901-4124
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-3000
  • Fax: 302-730-3579
Mailing address:
  • Phone: 302-730-3000
  • Fax: 302-730-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2006202284
License Number StateDE

VIII. Authorized Official

Name: MR. DYNEZ BOLDEN
Title or Position: DIRECTOR OF OPERATIONS
Credential: NREMT-B
Phone: 302-730-3578