Provider Demographics
NPI:1841562923
Name:GREAT WESTERN TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:GREAT WESTERN TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-908-0694
Mailing Address - Street 1:6315 FM 1488 RD STE B
Mailing Address - Street 2:#217
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2526
Mailing Address - Country:US
Mailing Address - Phone:888-909-0649
Mailing Address - Fax:
Practice Address - Street 1:6315 FM 1488 RD STE B
Practice Address - Street 2:#217
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2526
Practice Address - Country:US
Practice Address - Phone:888-909-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)