Provider Demographics
NPI:1740675941
Name:DR RCD TRANSPORT
Entity type:Organization
Organization Name:DR RCD TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:BA
Authorized Official - Phone:314-952-9530
Mailing Address - Street 1:4351 DELMAR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2625
Mailing Address - Country:US
Mailing Address - Phone:314-932-7301
Mailing Address - Fax:314-289-9456
Practice Address - Street 1:4351 DELMAR BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2625
Practice Address - Country:US
Practice Address - Phone:314-932-7301
Practice Address - Fax:314-289-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM208259031343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)