Provider Demographics
NPI:1316358096
Name:TABAAHA TRANSPORT LLC
Entity Type:Organization
Organization Name:TABAAHA TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-551-1463
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0644
Mailing Address - Country:US
Mailing Address - Phone:928-551-1463
Mailing Address - Fax:
Practice Address - Street 1:101 PINE HILL BLVD
Practice Address - Street 2:RIO PUERCO HSE
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-551-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)