Provider Demographics
NPI:1952012544
Name:TRANSPORT 43 LLC
Entity Type:Organization
Organization Name:TRANSPORT 43 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRIFFITH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BIBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-284-1578
Mailing Address - Street 1:3210 S CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5208
Mailing Address - Country:US
Mailing Address - Phone:208-284-1578
Mailing Address - Fax:888-894-7961
Practice Address - Street 1:3210 S CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5208
Practice Address - Country:US
Practice Address - Phone:208-284-1578
Practice Address - Fax:888-894-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)