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General NPI Number Information
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NPI Number | 1053044404
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Entity Type | Organization
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Legal Business Name | T AND T AMERICA
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 4835 S 73RD EAST AVE
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City | TULSA
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State | OK
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Zip | 74145-6553
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Country | US
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Telephone | 479-306-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 3198 HIGHWAY 412
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City | COLCORD
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State | OK
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Zip | 74338-1356
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Country | US
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Telephone | 479-365-7096
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | THIMOTEE ILBOUDO
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Credential |
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Telephone | 479-365-7096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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