Healthcare Provider Details

I. General information

NPI: 1245780899
Provider Name (Legal Business Name): WHITE GLOVE TRANSPORTATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 INDUSTRY LN SUITE A
DURHAM NC
27713-1974
US

IV. Provider business mailing address

PO BOX 12821
RTP NC
27709-2821
US

V. Phone/Fax

Practice location:
  • Phone: 919-424-4516
  • Fax:
Mailing address:
  • Phone: 919-424-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND MACKEY
Title or Position: MANAGER
Credential:
Phone: 919-424-4516