Provider Demographics
NPI:1740716992
Name:TRI STATE EMERGENCY TRANSPORT TEAM
Entity type:Organization
Organization Name:TRI STATE EMERGENCY TRANSPORT TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON-GLEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-878-5950
Mailing Address - Street 1:321 FORREST AVENUE
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018
Mailing Address - Country:US
Mailing Address - Phone:859-878-5959
Mailing Address - Fax:
Practice Address - Street 1:321 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1683
Practice Address - Country:US
Practice Address - Phone:859-878-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN.A343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)