Healthcare Provider Details

I. General information

NPI: 1720915101
Provider Name (Legal Business Name): SURETRIP TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 S MAPLE AVE
BROKEN ARROW OK
74012-6672
US

IV. Provider business mailing address

1825 S MAPLE AVE
BROKEN ARROW OK
74012-6672
US

V. Phone/Fax

Practice location:
  • Phone: 918-521-0192
  • Fax:
Mailing address:
  • Phone: 918-521-0192
  • 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: MR. WESLEY DERRINGER GRAY SR.
Title or Position: DRIVER
Credential: OWNER
Phone: 918-230-3022