Provider Demographics
NPI:1205154002
Name:AGILE SPECIALTY TRANSPORTATION, LLC
Entity type:Organization
Organization Name:AGILE SPECIALTY TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR.
Authorized Official - Prefix:MR
Authorized Official - First Name:FEONN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-443-7565
Mailing Address - Street 1:320 BROOKES DR STE 212
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2740
Mailing Address - Country:US
Mailing Address - Phone:314-443-7565
Mailing Address - Fax:314-355-5130
Practice Address - Street 1:320 BROOKES DR STE 212
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2740
Practice Address - Country:US
Practice Address - Phone:314-443-7565
Practice Address - Fax:314-355-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0888387341600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance