Provider Demographics
NPI:1003023185
Name:SECURE TRANSPORTATION
Entity Type:Organization
Organization Name:SECURE TRANSPORTATION
Other - Org Name:SECURE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-567-1800
Mailing Address - Street 1:3341 TOWERWOOD DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:469-567-1800
Mailing Address - Fax:972-241-5177
Practice Address - Street 1:3341 TOWERWOOD DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:469-567-1800
Practice Address - Fax:972-241-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB736OtherBLUE CROSS BLUE SHIELD
TXAMB426Medicare ID - Type Unspecified