Provider Demographics
NPI:1104223064
Name:SHIRLEY'S MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:SHIRLEY'S MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-860-7919
Mailing Address - Street 1:2819 W PENTAGON PKWY
Mailing Address - Street 2:E239
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-2201
Mailing Address - Country:US
Mailing Address - Phone:214-860-7919
Mailing Address - Fax:
Practice Address - Street 1:2819 W PENTAGON PKWY
Practice Address - Street 2:E239
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-2201
Practice Address - Country:US
Practice Address - Phone:214-860-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28522220343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)