Provider Demographics
NPI:1710232590
Name:NAVAJO EXPRESS
Entity Type:Organization
Organization Name:NAVAJO EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-6332
Mailing Address - Street 1:PO BOX 2374
Mailing Address - Street 2:05 TUMBLEWEED DRIVE
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-2374
Mailing Address - Country:US
Mailing Address - Phone:928-283-6332
Mailing Address - Fax:928-283-6332
Practice Address - Street 1:05 TUMBLEWEED DRIVE
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-2374
Practice Address - Country:US
Practice Address - Phone:928-283-6332
Practice Address - Fax:928-283-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZB10917167343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)