Provider Demographics
NPI:1073655684
Name:BUFFALO RIVER TRANSPORT
Entity Type:Organization
Organization Name:BUFFALO RIVER TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-589-2583
Mailing Address - Street 1:110 HOLDER STATION RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-6054
Mailing Address - Country:US
Mailing Address - Phone:931-589-2583
Mailing Address - Fax:931-589-3004
Practice Address - Street 1:110 HOLDER STATION RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-6054
Practice Address - Country:US
Practice Address - Phone:931-589-2583
Practice Address - Fax:931-589-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN320928343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN181614OtherBB TENNSELECT
TNT000151Medicaid