Provider Demographics
NPI:1558876375
Name:276 EXPRESS LLC
Entity Type:Organization
Organization Name:276 EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLEMAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-613-9050
Mailing Address - Street 1:150 W RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-3585
Mailing Address - Country:US
Mailing Address - Phone:276-613-9050
Mailing Address - Fax:276-335-2015
Practice Address - Street 1:150 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-3585
Practice Address - Country:US
Practice Address - Phone:276-613-9050
Practice Address - Fax:276-335-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi