Provider Demographics
NPI:1194358101
Name:VINE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:VINE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-698-5059
Mailing Address - Street 1:12817 BELLA VITA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4941
Mailing Address - Country:US
Mailing Address - Phone:585-698-5059
Mailing Address - Fax:682-250-5705
Practice Address - Street 1:6251 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3119
Practice Address - Country:US
Practice Address - Phone:682-250-5700
Practice Address - Fax:682-250-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)