904 West Main LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

904 WEST MAIN LLC

Doing business as

Direct Medical Transport

Practice address

130 Airport Dr Ste B
Farmington, NM 87401-5520

Phone

(505) 793-6750

NPI assigned

Mar 14, 2023

Last updated

Sep 2, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kurt Cook

Title

Owner

Phone

(505) 793-6750

Specialties & licenses 1

Addresses

Other names 1

• Direct Medical Transport Doing business as

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Tax ID family

904 West Main LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 904 West Main LLC

  dba Direct Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Farmington, NM
  • NPI 1235964172
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• 904 West Main LLC

  dba Direct Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Farmington, NM
  • NPI 1235964172

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725235200000",
    "number": "1003517228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 AIRPORT DR STE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015520",
            "telephone_number": "505-793-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 AIRPORT DR STE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015520",
            "telephone_number": "505-793-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "904 WEST MAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-14",
        "last_updated": "2024-09-02",
        "certification_date": "2024-09-02",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-793-6750"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Direct Medical Transport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-emergency Medical Transport (VAN) in Farmington, NM
• Providers in Farmington, NM by specialty
• Non-emergency Medical Transport (VAN) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.