Provider Demographics
NPI:1376032078
Name:YOUR GOLDEN TRANSPORTATION LLC
Entity Type:Organization
Organization Name:YOUR GOLDEN TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-489-6294
Mailing Address - Street 1:289 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-3527
Mailing Address - Country:US
Mailing Address - Phone:662-489-6294
Mailing Address - Fax:662-489-1145
Practice Address - Street 1:289 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-3527
Practice Address - Country:US
Practice Address - Phone:662-489-6294
Practice Address - Fax:662-489-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)