Provider Demographics
NPI:1205361888
Name:SPRY TRANSPORT INC
Entity Type:Organization
Organization Name:SPRY TRANSPORT INC
Other - Org Name:SPRY MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEEQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-300-2987
Mailing Address - Street 1:14252 CULVER DR
Mailing Address - Street 2:SUITE # A-253
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0317
Mailing Address - Country:US
Mailing Address - Phone:949-735-4400
Mailing Address - Fax:
Practice Address - Street 1:14252 CULVER DR
Practice Address - Street 2:SUITE # A-253
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0317
Practice Address - Country:US
Practice Address - Phone:949-735-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANEW APPLICANTOtherNEW APPLICANT