Provider Demographics
NPI:1407158694
Name:TRICARE MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:TRICARE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANERI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:609-646-1002
Mailing Address - Street 1:825 NOAHS ROAD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232
Mailing Address - Country:US
Mailing Address - Phone:609-646-1002
Mailing Address - Fax:609-241-6098
Practice Address - Street 1:825 NOAHS ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-646-1002
Practice Address - Fax:609-241-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJT02120873416L0300X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)