Provider Demographics
NPI:1508338823
Name:BRONCO EXPRESS COMPANY
Entity Type:Organization
Organization Name:BRONCO EXPRESS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-548-6219
Mailing Address - Street 1:6020 BRIARCLIFF PATH APT A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7449
Mailing Address - Country:US
Mailing Address - Phone:269-343-3000
Mailing Address - Fax:269-343-3309
Practice Address - Street 1:124 LAKE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2807
Practice Address - Country:US
Practice Address - Phone:269-343-3000
Practice Address - Fax:269-343-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
B200OtherMTM