Provider Demographics
NPI:1679121230
Name:EAGLE SPIRIT TRANSPORTATION
Entity type:Organization
Organization Name:EAGLE SPIRIT TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-701-9447
Mailing Address - Street 1:16 ASHMONT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2886
Mailing Address - Country:US
Mailing Address - Phone:774-701-9447
Mailing Address - Fax:
Practice Address - Street 1:16 ASHMONT AVE APT 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2886
Practice Address - Country:US
Practice Address - Phone:774-701-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)