Healthcare Provider Details

I. General information

NPI: 1770039984
Provider Name (Legal Business Name): COUNTRYWADE TRANSPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHRISTIE XING
CELINA TX
75009-3336
US

IV. Provider business mailing address

501 CHRISTIE XING
CELINA TX
75009-3336
US

V. Phone/Fax

Practice location:
  • Phone: 817-637-3193
  • Fax: 817-617-2321
Mailing address:
  • Phone: 817-637-3193
  • Fax: 817-617-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number34
License Number StateTX

VIII. Authorized Official

Name: OLATOKUNBO NOIKI
Title or Position: GENERAL MANAGER
Credential:
Phone: 817-637-3193