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General NPI Number Information
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NPI Number | 1093015976
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Entity Type | Organization
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Legal Business Name | 3 CANYONS TRANSIT CO. LLC
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 4771 E HEREFORD RD
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City | HEREFORD
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State | AZ
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Zip | 85615-9415
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Country | US
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Telephone | 520-803-6713
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Fax | 520-803-7080
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Provider Business Mailing Address
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Address Line | PO BOX 1431
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City | HEREFORD
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State | AZ
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Zip | 85615-1431
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Country | US
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Telephone | 520-803-6713
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Fax | 520-803-7080
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Authorized Official
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Title or Position | OWNER MEMBER MANAGER
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Name | MR. TONY C. GRZYWA
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Credential |
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Telephone | 520-803-6713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | AZ
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