Provider Demographics
NPI:1134581069
Name:PIVOTAL TRANSPORTATION
Entity type:Organization
Organization Name:PIVOTAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-454-1451
Mailing Address - Street 1:110 TRACI LYNN ST LOT 126
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1176
Mailing Address - Country:US
Mailing Address - Phone:443-454-1451
Mailing Address - Fax:
Practice Address - Street 1:110 TRACI LYNN ST LOT 126
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1176
Practice Address - Country:US
Practice Address - Phone:443-454-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance