=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760247316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B. & M. D TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2024
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3680 S TUCKER ST
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-9833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-787-5531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3680 S TUCKER ST
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-9833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-787-5531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. BELVET DOMINGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-787-5531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------