Healthcare Provider Details

I. General information

NPI: 1053598953
Provider Name (Legal Business Name): TECH TRANSPORT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W WALNUT ST
HAZLETON PA
18201-6133
US

IV. Provider business mailing address

PO BOX 515
HAZLETON PA
18201-0515
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-0928
  • Fax:
Mailing address:
  • Phone: 570-454-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1021172750001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: GEORGE W DENKE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 570-454-0928