Organization
BISON EXPRESS SHUTTLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J LARSEN JR. (OWNERGENERALMGR)
(928) 345-4615
Entity
Organization
Contact information
Practice address
12557 S FRONTAGE RD, YUMA, AZ 85367-5720
(928) 345-4615
(928) 345-9412
Mailing address
12557 S FRONTAGE RD, YUMA, AZ 85367-5720
(928) 345-4615
(928) 345-9412
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113014
GROUP BILLER NUMBER
AZ
01
—
113023
MTBA PROVIDER NUMBER
AZ
Enumeration date
02/14/2007
Last updated
08/22/2020
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