Provider Demographics
NPI:1336486638
Name:CW TRANSPORT
Entity Type:Organization
Organization Name:CW TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:O
Authorized Official - Last Name:WERITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-419-4672
Mailing Address - Street 1:5 COUNTY ROAD 5590 # 3013-L
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-1456
Mailing Address - Country:US
Mailing Address - Phone:505-419-4672
Mailing Address - Fax:
Practice Address - Street 1:335 DESERT ROSE TRAIL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-419-4672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)