Provider Demographics
NPI:1255114450
Name:LOCKETT AND ASSOCIATES LLC
Entity type:Organization
Organization Name:LOCKETT AND ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-435-6174
Mailing Address - Street 1:1851 E RENEGADE TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4455
Mailing Address - Country:US
Mailing Address - Phone:602-435-6174
Mailing Address - Fax:
Practice Address - Street 1:1851 E RENEGADE TRL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4455
Practice Address - Country:US
Practice Address - Phone:602-435-6174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)