Provider Demographics
NPI:1073397063
Name:DOUBLE T MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:DOUBLE T MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN,LNHA
Authorized Official - Phone:815-668-3777
Mailing Address - Street 1:11394 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9105
Mailing Address - Country:US
Mailing Address - Phone:815-668-3777
Mailing Address - Fax:
Practice Address - Street 1:11394 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9105
Practice Address - Country:US
Practice Address - Phone:815-668-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance