Provider Demographics
NPI:1629405071
Name:EXECUTIVE TRANSPFORTATION SERVICE, INC.
Entity Type:Organization
Organization Name:EXECUTIVE TRANSPFORTATION SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUPE'
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:202-554-1000
Mailing Address - Street 1:1515 HALF ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3412
Mailing Address - Country:US
Mailing Address - Phone:202-554-1000
Mailing Address - Fax:202-863-0775
Practice Address - Street 1:1515 HALF ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3412
Practice Address - Country:US
Practice Address - Phone:202-554-1000
Practice Address - Fax:202-863-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC343900000XOtherTRANSPORTATION