Provider Demographics
NPI:1437916152
Name:MITCHELLS TRANSPORT LLC
Entity Type:Organization
Organization Name:MITCHELLS TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:765-618-5274
Mailing Address - Street 1:19448 ROUDEBUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-9445
Mailing Address - Country:US
Mailing Address - Phone:765-618-5274
Mailing Address - Fax:
Practice Address - Street 1:19448 ROUDEBUSH BLVD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-9445
Practice Address - Country:US
Practice Address - Phone:765-618-5274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)