Provider Demographics
NPI:1699017491
Name:DINE' TRANSPORT
Entity Type:Organization
Organization Name:DINE' TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERDELL
Authorized Official - Middle Name:MYCHAL
Authorized Official - Last Name:DAWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-729-2130
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0074
Mailing Address - Country:US
Mailing Address - Phone:928-729-2130
Mailing Address - Fax:928-729-5475
Practice Address - Street 1:PIGEON SPRINGS NHA HOUSING HOUSE 062
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-2130
Practice Address - Fax:928-729-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle