Provider Demographics
NPI:1669828356
Name:TRIAD TRANSPORTATION, INC
Entity Type:Organization
Organization Name:TRIAD TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MAZZEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-837-1177
Mailing Address - Street 1:1017 PEWTER CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5203
Mailing Address - Country:US
Mailing Address - Phone:336-837-1175
Mailing Address - Fax:336-837-1177
Practice Address - Street 1:1400 OLD MILL CIR STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2977
Practice Address - Country:US
Practice Address - Phone:336-837-1175
Practice Address - Fax:336-837-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)