Provider Demographics
NPI:1184451528
Name:GLORIOUS PASSENGER TRANSPORTATION LLC
Entity type:Organization
Organization Name:GLORIOUS PASSENGER TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:TRANSPORT PROVIDER
Authorized Official - Phone:251-593-1303
Mailing Address - Street 1:3620 COUNTY ROAD 42
Mailing Address - Street 2:
Mailing Address - City:PETERMAN
Mailing Address - State:AL
Mailing Address - Zip Code:36471-3922
Mailing Address - Country:US
Mailing Address - Phone:251-593-1303
Mailing Address - Fax:251-564-2040
Practice Address - Street 1:3620 COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:PETERMAN
Practice Address - State:AL
Practice Address - Zip Code:36471-3922
Practice Address - Country:US
Practice Address - Phone:251-593-1303
Practice Address - Fax:251-564-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)