Provider Demographics
NPI:1902559453
Name:TRIPLE C TRANSPORTATION LLC
Entity Type:Organization
Organization Name:TRIPLE C TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-836-4606
Mailing Address - Street 1:4424 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8881
Mailing Address - Country:US
Mailing Address - Phone:804-836-4606
Mailing Address - Fax:
Practice Address - Street 1:4424 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8881
Practice Address - Country:US
Practice Address - Phone:804-836-4606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0Medicaid