Provider Demographics
NPI:1376697052
Name:PRESCOTT WHIPPLE STAGE
Entity Type:Organization
Organization Name:PRESCOTT WHIPPLE STAGE
Other - Org Name:PRESCOTT TRANSIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SILVERNALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-7978
Mailing Address - Street 1:820 E SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3214
Mailing Address - Country:US
Mailing Address - Phone:928-778-7978
Mailing Address - Fax:928-778-9797
Practice Address - Street 1:820 E SHELDON ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3214
Practice Address - Country:US
Practice Address - Phone:928-778-7978
Practice Address - Fax:928-778-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ072992OtherAHCCCS