Provider Demographics
NPI:1558696617
Name:DMV SHUTTLE SERVICE
Entity Type:Organization
Organization Name:DMV SHUTTLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-3345
Mailing Address - Street 1:3163 N JEROME ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4367
Mailing Address - Country:US
Mailing Address - Phone:928-753-3345
Mailing Address - Fax:928-753-3345
Practice Address - Street 1:3163 N JEROME ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4367
Practice Address - Country:US
Practice Address - Phone:928-753-3345
Practice Address - Fax:928-753-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)