Provider Demographics
NPI:1144731779
Name:LATRIKUNDA TRANSPORT SERVICES, LLC
Entity type:Organization
Organization Name:LATRIKUNDA TRANSPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER/COO
Authorized Official - Prefix:
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-991-5906
Mailing Address - Street 1:PO BOX 85658
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5658
Mailing Address - Country:US
Mailing Address - Phone:520-991-5906
Mailing Address - Fax:
Practice Address - Street 1:3450 S BROADMONT DR STE 108
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5245
Practice Address - Country:US
Practice Address - Phone:520-991-5906
Practice Address - Fax:520-777-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ073406Medicaid