Provider Demographics
NPI:1295470458
Name:PREMIER EXPRESS TRANSPORT LLC
Entity Type:Organization
Organization Name:PREMIER EXPRESS TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-941-3763
Mailing Address - Street 1:782 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2544
Mailing Address - Country:US
Mailing Address - Phone:440-941-3763
Mailing Address - Fax:
Practice Address - Street 1:782 E 130TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2544
Practice Address - Country:US
Practice Address - Phone:440-941-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle