Provider Demographics
NPI:1710250139
Name:SHUTTLE SQUAD L.L.C.
Entity Type:Organization
Organization Name:SHUTTLE SQUAD L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:BERROSPE
Authorized Official - Last Name:SPARKS BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-575-4559
Mailing Address - Street 1:17306 BONNARD CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6276
Mailing Address - Country:US
Mailing Address - Phone:713-575-4559
Mailing Address - Fax:
Practice Address - Street 1:17306 BONNARD CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6276
Practice Address - Country:US
Practice Address - Phone:713-575-4559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)