MEDICARE: ARCHIES & SONS 3RD COAST TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	342000000X	Transportation Network Company

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215509856	OTHER		NPI

General Provider Information

NPI Number	:	1235809203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHIES & SONS 3RD COAST TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	16039 LAUSANNE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-2086
Country	:	US
Telephone Number	:	832-995-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	14405 WALTERS RD STE 840
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1351
Country	:	US
Telephone Number	:	832-995-0031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EARNEST ARCHIE
Credential	:
Telephone Number	:	832-995-0031

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/06/2024

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