Provider Demographics
NPI:1265149132
Name:IRVINE TRANSPORT LLC
Entity type:Organization
Organization Name:IRVINE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-301-8643
Mailing Address - Street 1:4297 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:LA
Mailing Address - Zip Code:70730-3140
Mailing Address - Country:US
Mailing Address - Phone:225-301-8643
Mailing Address - Fax:
Practice Address - Street 1:4297 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:ETHEL
Practice Address - State:LA
Practice Address - Zip Code:70730-3140
Practice Address - Country:US
Practice Address - Phone:225-301-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)