=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760081491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DD MEDTRANS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2020
-----------------------------------------------------
Last Update Date | 10/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6333 E CATALINA DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-7014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-220-3834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6333 E CATALINA DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-7014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-220-3834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP NATIONAL ACCOUNTS
-----------------------------------------------------
Name | MR. LON MACKEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-764-2970
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------