Provider Demographics
NPI:1538487988
Name:TRISTAN TRANSPORTATION COMPANY
Entity Type:Organization
Organization Name:TRISTAN TRANSPORTATION COMPANY
Other - Org Name:TRISTAN TRANSPORTATION COMPANY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROWRICH
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:480-797-5257
Mailing Address - Street 1:18833 N 43RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3736
Mailing Address - Country:US
Mailing Address - Phone:480-797-5257
Mailing Address - Fax:480-994-1124
Practice Address - Street 1:18833 N 43RD PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3736
Practice Address - Country:US
Practice Address - Phone:480-797-5257
Practice Address - Fax:480-994-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRISTAN TRANSPORTATION COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD00817896343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)