1609146422 NPI number — 123 TRANSPORTATION, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609146422 NPI number — 123 TRANSPORTATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
123 TRANSPORTATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
123 MEDICAL TRANSPORTATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609146422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1941
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48121-1941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-799-1340
Provider Business Mailing Address Fax Number:
313-436-4399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25134 RIVERDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-799-1340
Provider Business Practice Location Address Fax Number:
313-436-4399
Provider Enumeration Date:
01/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BAZZY
Authorized Official First Name:
MOUNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-799-1340

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  L-2717 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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