Healthcare Provider Details

I. General information

NPI: 1457698995
Provider Name (Legal Business Name): SIMPLE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MESA FARM ROAD 1ST WASH
SHIPROCK NM
87420-2196
US

IV. Provider business mailing address

PO BOX 2196
SHIPROCK NM
87420-2196
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-3911
  • Fax: 505-368-3914
Mailing address:
  • Phone: 505-368-3911
  • Fax: 505-368-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberD00249013
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberD00249013
License Number StateAZ

VIII. Authorized Official

Name: BEATRICE REDFETHER
Title or Position: OWNER
Credential:
Phone: 505-368-3911