Provider Demographics
NPI:1265230080
Name:WEZESHA TRANSPORT LLC
Entity type:Organization
Organization Name:WEZESHA TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-995-5275
Mailing Address - Street 1:1111 MAIN ST # 974
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5455
Mailing Address - Country:US
Mailing Address - Phone:870-995-5275
Mailing Address - Fax:
Practice Address - Street 1:2107 PLEASANT VALLEY DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7203
Practice Address - Country:US
Practice Address - Phone:870-995-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)