Healthcare Provider Details

I. General information

NPI: 1518100478
Provider Name (Legal Business Name): SENTRY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8516 S LANCASTER RD
DALLAS TX
75241-6310
US

IV. Provider business mailing address

8516 S. LANCASTER RD
DALLAS TX
75241
US

V. Phone/Fax

Practice location:
  • Phone: 469-865-0524
  • Fax:
Mailing address:
  • Phone:
  • 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. KEITH WAYNE SMITH SR.
Title or Position: OWNER
Credential:
Phone: 469-865-0524