Provider Demographics
NPI:1861903981
Name:CLEAR CHOICE EXPRESS LLC
Entity type:Organization
Organization Name:CLEAR CHOICE EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:ADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-529-2060
Mailing Address - Street 1:1308 N STOCKTON HILL RD # A265
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5139
Mailing Address - Country:US
Mailing Address - Phone:928-529-2060
Mailing Address - Fax:928-543-7723
Practice Address - Street 1:2614 TRIANGLE S ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-7344
Practice Address - Country:US
Practice Address - Phone:928-529-2060
Practice Address - Fax:928-543-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50593343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ50593OtherAZ. DOT NUMBER
AZ1000048853OtherBETTER BUSINESS BUREAU NUMBER