Provider Demographics
NPI:1376254391
Name:OLIVER'S BRANCH TRANSPORTATION
Entity Type:Organization
Organization Name:OLIVER'S BRANCH TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAWENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORGILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-465-8663
Mailing Address - Street 1:5584 ARNOLD PALMER DR APT 126
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2409
Mailing Address - Country:US
Mailing Address - Phone:239-465-8663
Mailing Address - Fax:
Practice Address - Street 1:5584 ARNOLD PALMER DR APT 126
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2409
Practice Address - Country:US
Practice Address - Phone:239-465-8663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)