Provider Demographics
NPI:1639948128
Name:BRYANT TRIBE TRANSPORT LLC
Entity Type:Organization
Organization Name:BRYANT TRIBE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-516-1548
Mailing Address - Street 1:7022 W 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3528
Mailing Address - Country:US
Mailing Address - Phone:463-246-0714
Mailing Address - Fax:
Practice Address - Street 1:2002 HIGH EAGLE TRL APT 1028
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-4237
Practice Address - Country:US
Practice Address - Phone:463-246-0714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)