Provider Demographics
NPI:1770254542
Name:BOOM TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:BOOM TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-948-6776
Mailing Address - Street 1:27222 FULSHEAR BEND DR APT 3308
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1209
Mailing Address - Country:US
Mailing Address - Phone:310-948-6776
Mailing Address - Fax:
Practice Address - Street 1:27222 FULSHEAR BEND DR APT 3308
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1209
Practice Address - Country:US
Practice Address - Phone:310-948-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)