Healthcare Provider Details

I. General information

NPI: 1487228102
Provider Name (Legal Business Name): TLW TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHURCH ST # 224B
FERGUSON MO
63135-2442
US

IV. Provider business mailing address

119 CHURCH ST # 224B
FERGUSON MO
63135-2442
US

V. Phone/Fax

Practice location:
  • Phone: 314-736-9647
  • Fax:
Mailing address:
  • Phone: 314-736-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY WATSON
Title or Position: OWNER
Credential:
Phone: 314-736-9647