Provider Demographics
NPI:1003427410
Name:MOUNTAIN CHARIOT LLC
Entity Type:Organization
Organization Name:MOUNTAIN CHARIOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-259-6609
Mailing Address - Street 1:8206 LOUISIANA BLVD NE STE A310
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1738
Mailing Address - Country:US
Mailing Address - Phone:805-259-6609
Mailing Address - Fax:
Practice Address - Street 1:8206 LOUISIANA BLVD NE STE A310
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1738
Practice Address - Country:US
Practice Address - Phone:805-259-6609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)