Provider Demographics
NPI:1255628160
Name:DOMINION TRANSPORTATION LLC
Entity type:Organization
Organization Name:DOMINION TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-471-1670
Mailing Address - Street 1:8305 WHITCOMB ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-5701
Mailing Address - Country:US
Mailing Address - Phone:313-471-1670
Mailing Address - Fax:313-887-9952
Practice Address - Street 1:8305 WHITCOMB ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-5701
Practice Address - Country:US
Practice Address - Phone:313-471-1670
Practice Address - Fax:313-887-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)