Provider Demographics
NPI:1588204697
Name:SWIFT TRIP TRANSPORT
Entity Type:Organization
Organization Name:SWIFT TRIP TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:EVONNE
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-904-3982
Mailing Address - Street 1:5 EAGLE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2065
Mailing Address - Country:US
Mailing Address - Phone:281-904-3982
Mailing Address - Fax:
Practice Address - Street 1:5 EAGLE LAKE CT
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2065
Practice Address - Country:US
Practice Address - Phone:281-904-3982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)