Provider Demographics
NPI:1225488695
Name:ROLLIN SHUTTLE SERVICES
Entity Type:Organization
Organization Name:ROLLIN SHUTTLE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-521-1345
Mailing Address - Street 1:861 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-5417
Mailing Address - Country:US
Mailing Address - Phone:208-390-3930
Mailing Address - Fax:888-413-3331
Practice Address - Street 1:861 SAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-5417
Practice Address - Country:US
Practice Address - Phone:208-390-3930
Practice Address - Fax:888-413-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDW68680343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)