Provider Demographics
NPI:1841785896
Name:TDP TRANSPORT
Entity Type:Organization
Organization Name:TDP TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-9594
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2947
Mailing Address - Country:US
Mailing Address - Phone:910-738-9594
Mailing Address - Fax:910-738-9409
Practice Address - Street 1:1848 US HIGHWAY 74 W
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-5661
Practice Address - Country:US
Practice Address - Phone:910-738-9594
Practice Address - Fax:910-738-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCZE7632343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)