Provider Demographics
NPI:1629209127
Name:BLUE CREEK TRANSPORT LLC
Entity Type:Organization
Organization Name:BLUE CREEK TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BLUE CREEK TRANSPORT LLC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-446-1722
Mailing Address - Street 1:P.O. BOX 962
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0962
Mailing Address - Country:US
Mailing Address - Phone:406-446-1722
Mailing Address - Fax:406-466-1722
Practice Address - Street 1:7042 US HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-0962
Practice Address - Country:US
Practice Address - Phone:406-446-1722
Practice Address - Fax:406-466-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus