Provider Demographics
NPI:1184196818
Name:SOUTHWEST TRANSPORTATION GROUP
Entity Type:Organization
Organization Name:SOUTHWEST TRANSPORTATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMM
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-823-4320
Mailing Address - Street 1:4231 FREDERICK LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-2021
Mailing Address - Country:US
Mailing Address - Phone:269-823-4320
Mailing Address - Fax:
Practice Address - Street 1:4231 FREDERICK LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-2021
Practice Address - Country:US
Practice Address - Phone:269-823-4320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)