Provider Demographics
NPI:1356639884
Name:TANGLE WATER NON EMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:TANGLE WATER NON EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:QUINTAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:435-678-2968
Mailing Address - Street 1:881 E BROWNS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3320
Mailing Address - Country:US
Mailing Address - Phone:435-678-2968
Mailing Address - Fax:
Practice Address - Street 1:881 E BROWNS CANYON RD
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3320
Practice Address - Country:US
Practice Address - Phone:435-678-2968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle